The Society Volunteer Application

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Thank you for your interest in volunteering at our organization! Please complete the below application and we will be in touch! If you have any questions or need more information please email volunteer@shc-medina.org

Required Information:

First & Last Name: *

Date of Birth: *

YYYY

Address (include City, State, Zip): *

Phone Number: *

Email: *

Have you ever been convicted of a crime? *

Yes

Have you ever been convicted of a felony misdemeanor? *

Yes

If you answered yes to the above question, please explain:

Have you been a resident of Ohio for 5 years or more? *

Yes

Person to notify in case of an emergency: *

Emergency Contact Address: *

Emergency Contact Phone Number: *

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