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CCS Volunteer Application
First Name *
Your answer
Middle Name *
Your answer
Last Name *
Your answer
Street Address *
Your answer
City, State, Zip *
Your answer
Phone *
Your answer
Your answer
Is this application for a JOBS PLUS/DHS Work Experience program? *
Is this application for court-ordered community service? *
At this time we are not considering applicants for court-ordered community service unless you have 40 hours or more to fulfill.
Are you currently receiving or have ever received CCS services? *
If yes, please provide details.
Your answer
When are you available? (check all that apply)
Where are you interested in volunteering?
Volunteer Opportunities (check all you are interested in)
In an emergency, notify:
Please provide their name and phone number.
Your answer
Signature *
By writing my name below, I acknowledge that I am volunteering for Catholic Community Services of Lane County, Inc. (CCS). I agree to absolve and hold harmless CCS from and against any blame and liability for any injury, misadventure, harm, loss, inconvenience, or damage hereby suffered or sustained resulting from participation as a volunteer for CCS. I understand that information provided by clients and the content of discussions or other communications regarding clients and client information by CCS personnel are confidential and privileged. I understand that said information may not be divulged to any person outside of CCS without a court order. I promise not to divulge or otherwise make public such information whether obtained from clients or from CCS personnel.I give permission to use any photograph, video recording or audio recording of myself, obtained during volunteer activities, in CCS informational material and for CCS publicity, training and promotional purposes and without compensation from CCS. I read and understand the above.
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