Volunteer Registration

This form must be completed by the applicant. When you complete and submit the form, it will be emailed to PCR and copied to the email address you enter below.

You must print a copy of this form before you send it and bring it with you for your interview with PCR. To do that, please fill out the form completely, then click the printer icon. That will give you a printable page in a new browser window. Print the form. Close the print page. Click the Send button to send us your information.

Personal Information
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Your Age*
Phone*
Phone 2
Email*
Emergency Contact Name*
Emergency Contact Phone*
Education/Occupation
Current Educational Institution/Employer
Undergraduate/Graduate Degree & Major
Graduation Year
What motivated you to volunteer with PCR?*
Photo Release*
May PCR use your photographic likeness for publicity purposes?
- Yes
- No
Disclosure*
I hereby declare or affirm under penalty of perjury that I have not been convicted of, nor am I the subject of pending charges for the commission or attempt to commit or assault with intent to commit murder, child abuse, rape, child pornography, child abduction, kidnapping of a child, manufacturing, distributing, or dispensing a controlled dangerous substance, or hiring, soliciting, engaging, or using a minor for the purpose of manufacturing, distributing, or delivering a controlled substance or sexual offense, defined under Article 27, Subsection 464, 464A, 464B, and 464C of the Annotated Code of Maryland or an equivalent offense and I certify I am the applicant whose information is listed above.
- Yes
- No

Personal Information

Education/Occupation

Contact Us

Quick Links

Mailing Address

Donate Now!