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  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.