Volunteer Application

    Volunteer Application

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    Date of Birth:

    Emergency Contact


    If you are seeking to volunteer to obtain credit with a particular program (club, school, court, etc.), please list below

    Please check below volunteer opportunities that may interest you:

    Applicant's Statement

    I hereby certify the answers on this application are true and correct. I authorize Dorchester Seniors, Inc., to verify all information contained in this application, including any references or any listed personnel. I understand that any misrepresentations or omissions of facts, misleading or false information on my part will be grounds for rejection of my application.

    If I am selected as a volunteer, I agree to hold confidentially all information to which I may have access in connection with my activities as a volunteer. This includes, but is not limited to, financial information and information on current, former, or prospective clients, volunteers and employees. Disclosure of such information to unauthorized persons is prohibited and may result in my immediate dismissal from the program and may have legal consequences.

    If I am selected as a volunteer, I agree my services will be donated to Dorchester Seniors, Inc. without contemplation of compensation or future employment. I am aware Dorchester Seniors does not provide insurance coverage for volunteers if personally injured or if damage occurs to the volunteer's personal property while acting as a volunteer. I agree that I will not hold Dorchester Seniors Inc., its affiliated entities, or their directors, employees, agents or insurers liable for any injury sustained to my person or property while acting in a volunteer capacity.

    My signature certifies I understand and agree to the above, have received a copy of the Volunteer Handbook, and do hereby agree to abide by its rules

    Your Signature: