Perkins Volunteer Application

Please fill out the following form. You can also download a PDF version »

If you have any questions contact Mike Cataruzolo at or 617-972-7224.

Emergency Contact

Education and Experience/Interests

(examples: CPR, First Aid, Water Safety, Sign Language, etcetera)

Volunteer Availability

(Format: mm/dd/yyyy)

(Format: mm/dd/yyyy)
Please indicate your areas of interest in order of priority

Personal References
Please list name, address, and telephone number of two character references, not including relatives:

I attest that all the above information is correct and accurate. I authorize Perkins to contact the above individuals for a character reference.

Typing your full name serves as your signature.
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