Contact Information

Date of Birth (00/00/0000)*
Confirm Email*
Phone (1234567890)*

Other Information

Shift Preference
  • Morning
  • Afternoon
  • Evening
How did your hear about us?*
Why do you want to volunteer at the Ronald McDonald House?*
Please let us know of any special skills, interests or expertise you would like to use in your volunteer role.
Volunteer Experience

Personal References

Reference 1 First and Last Name*
Relationship to Reference 1*
Reference 1 Email
Reference 1 Phone *
Reference 2 First and Last Name*
Relationship to Reference 2*
Reference 2 Email

Emergency Contact

Emergency Contact First and Last Name*
Relationship to Emergency Contact*
Emergency Contact Address*
Emergency Contact City, State and Zip*
Emergency Contact Phone Number*
Emergency Contact Email*


I hereby certify that the information contained in this application is correct to the best of my knowledge. I understand that before beginning my volunteer service, I will submit to a reference and background check as well as abide by and attend any additional orientation processes.


I understand that this application does not guarantee a volunteer placement with Ronald McDonald House Charities of Northeast Indiana (RMHC NEIN). I understand that should I be offered a volunteer position, any misrepresentation by me may lead to termination. I also understand that I will not receive payment for my service and that my volunteer service may be terminated with or without notice by RMHC NEIN. If I am unable to fulfill my scheduled commitment, I will notify RMHC NEIN with as much notice as possible.


I hereby expressly agree to maintain the confidentiality of any information (written, verbal, electronic or other form) I am privy to as a result of volunteering my time to work as a volunteer with RMHC NEIN. I understand that any breach of confidentiality shall result in immediate termination of duties and subjects me to possible legal action on the part of the RMHC NEIN from said breach.


I expressly agree that this Volunteer Release from Liability and Waiver is intended to be as broad and inclusive as permitted by the laws of the State of Indiana in the United States of America, and that this Volunteer Release from Liability and Waiver shall be governed by and interpreted in accordance with the laws of the State of Indiana. I agree that in the event that any clause or provision of this Volunteer Release from Liability and Waiver shall be held to be invalid by any court of competent jurisdiction, the invalidity of such clause or provision shall not otherwise affect the remaining provisions of this Release which shall continue to be enforceable.


I grant unto  RMHC NEIN all right, title and interest in any and all photographic images and video or audio recordings that are made by the RMHC NEIN during my work with the RMHC NEIN, including, but not limited to, any royalties, proceeds, or other benefits that are derived from such photographs or recordings. I authorize the release of my name and contact information to official RMHC NEIN staff and volunteers. I understand that my contact information will only be used to contact me for purposes related to my request and/or event communication.


By signing/typing your name here you acknowledge that you have read and agree to the above statements*
Additional Comments


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