Catholic Charities
Livingston County

Volunteer Registration Form

34 East State St. * Mt. Morris, NY 14510 
(585)658-4466
 DOWNLOAD FORM IN PDF


NAME (last, first, MI):  

ADDRESS (Street, City, State, Zip):  



PHONE: 

EMAIL: 

BEST TIME TO BE REACHED: 

DATE OF BIRTH: 

SKILLS/INTERESTS (Check all that apply)

















  • I prefer to work with:  ___Infants   ___Children   ___Teens   ___Adults  


                                         ___Seniors   ___ Any age   ___Behind the Scenes

  • I prefer to volunteer in the geographical area(s) in Livingston County: 

            ___Avon   ___Caledonia   ___Dansville   ___Geneseo   ___Lima  

           ___Livonia   ___Mt. Morris   ___Nunda   ___Springwater   ___York

          ___No Preference


  • I prefer to volunteer (per  month):  ___<2 hours ___2-4 hours ___>4 hours

             Other______________________________

  • I prefer to volunteer in the:  __mornings ___afternoons ___weekends

             ___as needed

  • Days Available: _______________________________________

  • If driving, driver's license #:________________ Expiration Date:_________

  • Insurance:________________________________________________

  • Have you ever been convicted of a felony or misdemeanor in any jurisdiction?

             ___Yes ___No If “Yes”, please list the specific nature and details of the crime(s), date(s), court location,sentencing information, and disposition of sentence on another sheet of paper.


  • Are there any pending criminal charges files against you?  

             ___Yes  ___No   Please specifiy_______________________________



In case of emergency contact:  

Name: 

Relationship: 

Address: 

Phone:  

Other Phone: 

I certify that all statements made by me on this application are true and complete to the bestof my knowledge. I understand that misrepresentation or omission of facts called for on this application is cause for rejection of this application or for subsequent dismissal.

I hereby acknowledge that I have read the above statement and understand the same.

Signature of Registrant:______________________________________________

Date:________________________

It is the policy of Catholic Charities to foster equal volunteer opportunities and affirmativeaction for applications without regard to race, color, sex, religion, national origin, age ordisability.

Please note that certain volunteer assignments will require the applicant to undergobackground checks as a prerequisite. Your cooperation is appreciated.