Volunteer Sign-Up Form: Care Coord

First name

Last name

Email

Phone

Birthday

Month

Day

Year

Address

Why are you interested in volunteering with the Care Coordination Program?

How many hours per month are you available to volunteer?

Are you available for special weekend events (optional)?

Are you able to commit to volunteering for at least 3 months?

What is your current role or occupation? (Student, Professional, Parent, etc.)

Are you seeking service hours for school or a program?

Yes

No

Other

Are you comfortable making outreach calls, texts, or follow-up emails to participants (scripts will be provided)?

Yes

No

Are you currently pursuing or do you hold a degree in Early Childhood Education, Social Work, Psychology, or a related helping profession?

Yes

No

Other

Do you have previous experience working with young children or families? (Briefly describe)

Do you have experience in any of the following areas? (Check all that apply)

Social work or public health

Community outreach

Working with families or parents

Healthcare navigation or advocacy

Administrative or data entry

None of the above, but I’m eager to learn!

Have you completed child abuse and criminal background clearances in the last 12 months?

Yes

No

Willing to obtain

If yes, please upload valid clearances less than a year old

Child Abuse, FBI Fingerprints, and Criminal Record Check

Are you comfortable being photographed during events for promotional purposes?

Yes

No

Emergency Contact Name

Emergency Contact Phone Number

Relationship to You

Is there anything else you'd like us to know?

A Philadelphia resource hub for children and families.