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Volunteer Application Form

Application form, consent form and social media release for all potential volunteers at Jeremiah's Inn.

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Select which opportunities you are interested in:


Limitations and Background

Do you have any physical limitations that may prevent you from climbing stairs and/or lifting 25+ lbs.?
By initialing above I understand that due to the vulnerable populations that Jeremiah's Inn works with all Food Pantry volunteers must pass a CORI background check.
Volunteers for Jeremiah's Inn are requested to arrive dressed appropriately for the work that they will be performing. This dress code has been developed with the safety of volunteers in mind, following work place safety standards and are designed to respect our clients. Please adhere to this code to insure that you will be able to fully take part during your day(s) of service. Volunteers arriving dressed inappropriately will not be allowed to take part unless suitable accommodations can be made. Volunteers must wear flat, closed-toed shoes. Please do not wear shoes with heels more than half an inch. Volunteers should not wear revealing or tight-fitting clothing. Do not wear tank tops, sleeveless or low-cut shirts, short-shorts or tight pants (including yoga pants, leggings, or tights). Acceptable clothing includes shirts that cover the stomach, and upper arms and chest, shorts that come within three inches of the knees, and long pants. A hat or hairnet is required for volunteers handling food. Hats should be brought from home (we suggest baseball caps) Please do not wear large /dress hats. Disposable gloves are required for volunteers handling food and will be provided by Jeremiah's Inn. If you find that you have any questions regarding this policy, please contact us at 508.755.6403 ext. 10 or [email protected]. We will be happy to discuss this and to insure that you have an enjoyable experience volunteering with Jeremiah's Inn.
I hereby release and hold harmless Jeremiah’s and any of its employees from any liabilities and claims arising from my participation in the volunteer program. I agree that I will never prosecute or in any way aid in the prosecuting of any demand, claim or suit against Jeremiah’s Inn, any officer, agency, or any employee acting officially and/or in good faith, for any loss, damage or injury to my person or property that may occur because of me taking part in the Volunteer Program. I accept full responsibility for the cost of treatment for any injury. I also understand and agree that I may be held liable for any damage or loss to Jeremiah’s Inn property and facilities that is caused by my own negligence, gross negligence, willful misconduct or fraud. I also understand and agree that I may be held liable for any damage or loss to any third party that is caused by my own negligence, gross negligence, willful misconduct or fraud. I further understand that Jeremiah’s Inn is fully insured and that any claims for any injuries must first be made against personal/family insurance and then against Jeremiah’s Inn Insurance. I accept that claims are limited to that which insurance provides and will not seek damages beyond those limits. By initialing here, I agree to the above and understand that I am a volunteer and that I am not an employee of Jeremiah's Inn.
Any information regarding clients of Jeremiah’s Inn is privileged and strictly confidential. No information, written or verbal, regarding clients should be shared outside Jeremiah’s Inn except in professional settings where the client has given permission to be discussed with specific individuals. It is against Jeremiah’s Inn policy to acknowledge that any individual is or has been a client of the Agency without the client’s specific written authorization. Responding to a telephone call inquiring about a current or former client or to a seemingly innocent inquirer asking about a client is considered a breach of confidentiality. Confidential information about clients may be revealed under certain conditions without the client’s permission. These conditions include: (1) when a client presents a clear and present danger to himself and refuses to accept appropriate treatment, (2) when a client makes an actual threat to kill or inflict serious bodily injury upon a reasonably identifiable victim, (3) in response to a court order issued by a judge, (4) when a staff member, in the course of his or her professional practice becomes aware of abuse of a child, and elderly person or a handicapped individual, (5) or when in the course of a 51A investigation, DSS requests information that might aid in determining whether abuse or neglect has occurred. The staff member MUST consult with their supervisor before any information is released under any circumstances. I have read the above policy statement and have had the opportunity to ask questions regarding the statement. I understand that strict adherence to this policy is a condition of working at Jeremiah’s Inn and any breach of confidentiality is grounds for termination from Jeremiah’s Inn. I also understand that by signing this statement, I am agreeing to maintain confidentiality of information regarding clients obtained while working at Jeremiah’s Inn both during and after the period of my employment or volunteering at Jeremiah’s Inn.
I, the undersigned, do hereby grant permission to Jeremiah’s Inn to post my photo to the Jeremiah’s Inn website (, and for the Jeremiah’s Inn Facebook, Instagram & Twitter accounts. I hereby release you, your representative, employees, managers, board members, and directors of Jeremiah’s Inn, from all claims and demands arising out of or in connection with any use of said photos including, without limitation, all claims for invasion of privacy, infringement of my right of publicity, defamation and any other personal and/or property rights. I acknowledge and agree that no sums whatsoever will be due to me as a result of the use and/or exploitation of the photos or any rights therein.

Person to call in case of an emergency


Electronic Signature

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