Adult Volunteer Registration Form If you have any questions please contact:Harriet KlatteVolunteer Coordinator412-408-3830 x 3204hzklatte@nhco.org Name * First Name Last Name Email * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Please send me NHCO’s monthly e-newsletter with volunteer opportunities. * Yes No NHCO may use my name and/or photo in publications, press releases or other publicity materials. * Yes No How did you learn about North Hills Community Outreach? * In case of emergency, please contact: * Emergency contact's relationship * Emergency contact's Phone * (###) ### #### In case of emergency, please contact: * Emergency contact's relationship * Emergency contact's Phone * (###) ### #### Current or previous employer and position * I am retired * Yes No I am a college student * Yes No Please contact me about asking my company for financial /in-kind /matching gifts. * Yes No Are you now or have you previously been an NHCO client? * Yes No Demographics (Optional – used for grant applications) Date of birth * MM DD YYYY What gender do you identify as? (Optional) Race/Ethnicity (Optional) African-American Hispanic Caucasian Asian-American Other Special skills, interests, or hobbies you’d like to share: Current or previous volunteer activities: Please check all of the following activities that interest you. * Receptionist Administrative Support Data Entry Special events/fundraisers Seasonal sharing projects (Volunteers needed July to December) Food pantry Physical labor/lifting * Free Rides for Seniors shuttles Community Organic Garden NHCO Office Ground Work In Service of Seniors - Transportation to Medical Appointments In Service of Seniors - Yard Work In Service of Seniors - Snow Shoveling In Service of Seniors - Transportation to the grocery store or other errands In Service of Seniors - Friendly visits In Service of Seniors - Mail sorting/helping with bills In Service of Seniors - Monthly food pantry delivery In Service of Seniors - Handyperson jobs Other Activities that you would prefer not to do: Physical/medical limitations of which we should be aware (steps, lifting, standing, etc.): Driving - Would you be willing to make local trips? Yes No Driving -If yes, please complete the following (check all that apply) In my vehicle In NHCO's van To run errands To transport clients To pick-up donations and drop-off at sites Make deliveries to clients' homes If you have a valid PA Driver’s License, please enter the number Do you have a large vehicle (truck, van, SUV) and am willing to use it for deliveries, pick-ups, etc. * Yes No Please describe your volunteering availability: * Is there a certain time of year when you are not available? * Check all locations at which you are willing to volunteer: Allison Park Millvale North Boroughs O’Hara (Senior Shuttle) How many hours can you volunteer (per week or per month) * Do you have a volunteer service requirement? * Yes No If yes, please tell us who is requiring you, how many hours you need, and when they need to be completed. I would like NHCO to speak at my church/civic group/organization/etc Yes No Confidentiality * I agree to treat as confidential all information, including contact information, belonging to clients, former clients, their families, other volunteers, donors, staff and board members that I learn during the performance of my duties as a North Hills Community Outreach volunteer. I understand that it is prohibited to share such information with any person, including relatives, friends, business and professional associates, unless NHCO authorizes such actions. I agree that if taking photos or selfies at NHCO events, I will not include photos of clients and/or post photos that include clients on social media. Additionally, I understand that it is the policy of NHCO that staff and board members will treat as confidential all information, including contact information, belonging to me, the volunteer, which has been obtained through my affiliation with NHCO. I understand that staff and board members will not share my information with any person, including relatives, friends, business and professional associates without my authorization unless such actions are required by law. By clicking yes, I acknowledge that I have read and agree with the above: Yes No Thank you for your interest in volunteering with North Hills Community Outreach. Somebody will get back to you shortly.
