Community Volunteer Request Form

Genesis HealthCare System is proud to have our employees volunteering in our local communities. To create more opportunities for our employees to volunteer you can request volunteers for events below. All requests will be reviewed by the Genesis Marketing & Public Relations department according to the set criteria. When a decision is made, we will contact you directly within five to seven business days.

Please review the following criteria for opportunities to be considered before submitting a request.

Supports health and wellness in our community
Benefits one of the six counties we serve (Coshocton, Guernsey, Morgan, Muskingum, Noble or Perry)
Not a political fundraiser or event
Not a memorial or fundraiser for one person
If a church function, it must benefit the community at large

Organization name:

Name of event:

Date and time of event:

Location of event:

Address

Address 2

City

State

ZIP code

Organization's contact name:

Organization's email:

Organization's phone number:

Number of volunteers requested:

Number of volunteer hours needed:

Brief description of event activities:

We rate all our volunteer events on an activity level basis. Please review the descriptions below and select which best describes the activity level volunteers should expect:

High activity

– includes mostly standing or moving activities, lifting some objects may be required.

Moderate activity

– includes some standing or moving activities but will also have the chance for seated activities.

Low activity

– includes mostly seated activities, not much physical movement involved.

Additional details: