(503) 325-0313 info@clatsopcare.org
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Volunteer Application

Name(Required)
Email(Required)
Birth Date(Required)
(If you are under the age of 18, you will need to fill out a Parental Consent Form)
Address(Required)
Work Phone

Additional Information

The information below is requested to help us better match volunteers to individual patients.
Programs or Activities
Please check all programs or activities you are interested in:
Weekday Availability (Mon-Fri)
Weekend Availability (Sat-Sun)
How did you learn about volunteering at Clatsop Care Center?
Please tell us about the reason for your interest in our programs. The more information and detail that you include, the better we will be able to make decisions about how to integrate you into the program.
T.B. Screening Test(Required)
To volunteer regularly at this facility you must consent to a T.B. screening test and a criminal background check. Do you consent to this?

Emergency Information

Emergency Contact Name(Required)

Clatsop Care
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646 16th Street, Astoria, OR 97103
info@clatsopcare.org | (503) 325-0313
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