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Make an impact in your community. Volunteer.

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Volunteer Application

35 Cerone Place, P.O. Box 2615, Newburgh, NY 12550
Office Hours: Monday - Friday, 9 AM until 12 Noon
Phone: (845)-562-3490

Click Here for PDF version

First name: *

Last name: *

Email address: *

Address: *

City: *

State: *

Zip Code: *

Home Phone: *

Mobile Phone:

Date of Birth: *

In case I have an emergency, please contact:

Emergency Contact Name: *

Relationship to me: *

Emergency Contact Phone: *

I am interested in volunteering as a (check all that apply): *

Driver

Kitchen Helper

Special Projects

How often are you available? (check all that apply) *

Weekly

Occasionally/Substitute

Emergency only

Do you have your own car? *

Yes

If you will be driving your own car, please give us a copy of both your NYS Driver's License and your current NYS Insurance ID card.

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