Charles & Lynn Zhang Portage Community Senior Center Volunteer Application

The New Charles & Lynn Zhang Portage Community Senior Center provides more opportunities for volunteers. Volunteers may assist with special events at the Senior Center and even drive the Senior Center van and more!

Phone Number

Please select the best ways(s) to contact you:

Phone (Voice)

Phone (Text)

Other (Please specify below)

Please specify "Other":

Driver's License State & Number (Only for Portage Senior Center van drivers):

Date of Birth (No minimum or maximum age for volunteers. Used for background checks only.):

Race (Used for background checks only.):

Gender (Used for background checks only.):

Please specify "Other" or list any other activities or events that you would like to volunteer for:

Please select how often you would like to volunteer:

Please specify "Other":

Please select the specific day(s) of the week you are interested in volunteering:

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Any Day

Please select your level of interest:

Meeting a school requirement.

Interested in a specific event.

Interested in making a 6 month or longer commitment.

Other (Please specify below)

Please specify "Other" and/or provide any additional information on level of interest or duration of volunteering below:

Have you been convicted of a felony?

By submitting this form, I authorize my former employers and school authorities to give any information regarding my employment, together with any information they may have regarding me whether or not it is on their records. I authorize the City of Portage to conduct a criminal record investigation and driving record investigation. I hereby release them and their organization from any damage whatsoever for issuing same. I understand this is not a compensatory position, nor a promise of one. Furthermore, I understand that as a volunteer, I am not able to collect benefits including, but not limited to, Workers' Compensation. I acknowledge that I am volunteering my time and when this arrangement is no longer desirable by either party, either the City of Portage or myself may terminate this relationship.

Sign Here

First Name

Last Name

Choose how to sign

Draw Type

I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.

If you are 17 years of age or younger, please have a parent/guardian complete the Youth Permission Slip located at the top of the "Volunteering" page of the City of Portage website.