Membership - Partners In Care Maryland

Want to volunteer with us/become a member? Download the Membership Agreement Form and then fill out your application below!

If you have questions, contact April Stup: aprilstup@partnersincare.org

Membership Agreement Form PDF · 13 kB

Membership Application

Full Name *
Street Address *
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Home Phone *
Other Phone
Email Address
Sex *
Date of Birth *
Marital Status *
Race *
Military Status *
Branch Served
Monthly Income *
How did you hear about Partners In Care?

Availability

During which hours are you available for volunteer assignments? Type all that apply. *
Monday AM; Monday PM Tuesday AM; Tuesday PM Wednesday AM; Wednesday PM Thursday AM; Thursday PM Friday AM; Friday PM Saturday AM; Saturday PM Sunday AM; Sunday PM Any day; Any time
Tell us in which areas you are willing to serve. Please type all that apply: *
South County: Edgewater & all points South Central County: Annapolis, Riva, Crownsville, Arnold, Severna Park, Millersville Outside County: Baltimore, Neighboring counties West County: Odenton, Gambrills, Jessup, Ft. Meade, Crofton, Bowie, Laurel North County: Brooklyn Park, Curtis Bay, Halethorpe, Glen Burnie, Linthicum, Hanover, Severn, Harmans, Pasadena

Special Skills & Interests

Summarize special skills and qualifications you have acquired from employment, previous volunteer work, or through other activities, including hobbies or sports. *

About You

What do we need to know about you in order to make a safe and effective match. (Ex. I am very social, I don't mind multiple trips, I use a cane, I'm allergic to cats...etc.) *

Emergency Contact

Name *
Relationship *
Street Address *
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Home Phone
Other Phone *

References (Please provide 2 NOT related to you)

Reference #1 Name *
Street Address
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Phone *
Reference #2 Name *
Street Address
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Phone *

Volunteer Opportunities Checklist

Transportation
Type which areas you are interested in: I will transport members in my car Volunteer Aid for Mobility Bus
Help the Program
Choose from the following: Receptionist, Transportation Ride Matching, Transporation Intake/Data Entry, Photography, Grant Writing, Entertainment, Database entry, Connect America Admin, General Admin, Fundraising, Translation, Program Advocacy (speaking/health fairs), Marketing/ Social Media, Event Planning
Repairs With Care
Type all that apply: Appliances, small repairs, Carpentry, Electrical (small), Masonry repairs, Plumbing (small), Yard work, gardening, FOAS-Bathroom safety equipment installation (training is offered for this task), Boutique donation picks-ups (small items/bags), Technology hook-up & assistance, Gutter cleaning, one story, Painting, Trash removal/ dump runs, Connect America Emergency Response System Installation (training is offered for this task)
Boutique (Anne Arundel County Only)
Type which areas you are interested in: Cash Register, Processing, Item Research (E-Bay, etc.), Staging
Member Care
Type which areas you are interested in: Household Upkeep (laundry, declutter, house cleaning), Baking, Respite, Warm Houses, Errands/Shopping (without member), Phone Buddy, Pet Care, Friendly Visit, Reading/Writing, Peer Advocacy, Learning Socials/Wellness Offerings, Intakes/Interviews
Professional Skills & Tasks
Type which areas you are interested in: Taxes, Case Management/ Social Work, Customer Service, CPA/ Accounting, Legal, Notary, Non-Profit, Community Partnerships
Upload Membership Agreement Download the Membership Agreement form at the top of this page. Fill it out, sign, scan or take a photo of it and upload it here. If you don't have scanner capabilities, you can fill out a hard copy at orientation.

Verification

Please enter any two digits *Example: 12
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