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Volunteer Form

  1. sign

  2. Portage Manor Volunteer Form

  3. *An approved Volunteer is here to benefit the resident's and facility at all times; the best interest of residents and facility will be maintained. A Volunteer can be dismissed at any time with or without cause and at the discretion of the Administrator.

  4. Department of Interest*

    Check one or more boxes

  5. Is volunteering:

  6. Contact Information

  7. Preferred method of contact:

  8. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

  9. Emergency Contact Information

    Used in the event of an unforeseen emergency

  10. Leave This Blank:

  11. This field is not part of the form submission.