Become a Member
  We welcome you to become a volunteer member of Partners In Care.


We use the tool of time-exchange as the basis for our program. This means that if you use your time and skills to help out, you'll receive help back from the community when you need it. It's about social responsibility and engagement. Everybody has something to contribute and is valued for it.

We encourage you to get involved. It's flexible and very gratifying.







Untitled Document
PARTNERS IN CARE MARYLAND, INC.

Supporting Older Adults In Our Community

MEMBERSHIP APPLICATION
*Required Fields
Personal Information
*Last Name
*First Name
Middle Name
*Today's Date
*Street Address
*City
*State
* Zip
*County
Home Phone
Mobile Phone
Work Phone
Other Phone
*Email
Mailing List
You can help us by giving your response to the following demographic inquiries.
This will only be used as statistical data when we apply for grants.
Date of Birth
Your Age Today
Gender
Marital Status
Home Owner
  
Living Arrangment
Ethnicity
Annual Income
Services I'm Interested In
How did you
find us
For those interested in receiving services, we'll contact you to arrange a personal in-home interview. For those interested in providing services, we will contact you about the next Orientation program in the office.
   
Membership Agreement

I, the undersigned, do affirm that all information contained in this application form is true and complete to the best of my knowledge. I am applying for membership in the Partners In Care Maryland, Inc. Program and I agree to abide by all the policies and procedures of the Partners In Care Maryland, Inc. Program.

I also understand that all information concerning Partners In Care Maryland, Inc. participants and services exchanged will be held in the strictest confidence.

I also understand that Partners In Care Maryland, Inc. is a coordinating agency only. The staff will refer people who state that they are able to perform requested services. Expenses for any materials used will be the responsibility of the consumer, and expenses will be agreed upon before the service is delivered. Partners In Care Maryland, Inc. cannot guarantee the performance of anyone who is referred, nor be responsible for any injury to persons or damage to property experienced while involved with the Program. The applicant hereby agrees to hold Partners In Care Maryland, Inc., as well as its employees and/or agents, harmless from any and all claims or liabilities for any work performed hereunder.
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*Security Code
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*By submitting this form, I agree to the above Membership Agreement.
   
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