VOLUNTEER APPLICATION FOR GEMMA'S ANGELS

 

How do I apply for a Pennsylvania Child Abuse History Clearance?

An individual can receive a Pennsylvania Child Abuse History Clearance one of three ways:

1. In person by walking into the office that processes Child Abuse History Clearances located at the following address:

Child Abuse Registry
Department of Human Services
5 Magnolia Drive (Hillcrest Building #53)
Harrisburg, Pa 17110

2. Submitting an application online by first creating a Child Welfare Account and completing the information electronically through the Child Welfare Portal (Gemma's Angels preferred method): https://www.compass.state.pa.us/cwis/public/home

3. Mailing in paper application (the Pennsylvania Child Abuse History Clearance – also known as the CY113) to the ChildLine and Abuse Registry at the below address. A paper copy of the clearance application may be found here: 

http://keepkidssafe.pa.gov/cs/groups/webcontent/documents/form/s_001762.pdf

ChildLine and Abuse Registry
Department of Human Services
P.O. Box 8170
Harrisburg, Pa 17105-8170

Click here for an online Frequently Asked Questions about the Pennsylvania Child Abuse History Clearance Program.

Note: As a volunteer, you do not have to pay the fee for this application. Contact Mike Macchioni at (717) 289-0150, extension 5, Gemma's Angels to be issued a State Payment Code.

Personal Information First Name Middle Initial Last Name

Home Address, including City & Zip code

Primary Phone

E-mail Address

Birthday (month and day)

Emergency Contact Information

Emergency Contact’s Name

Relationship Primary Phone Secondary Phone

Your Hospital Preference As a volunteer of The Caring Cupboard, I agree to the following statements:

1. I understand that any and all information regarding clients of The Caring Cupboard shall be considered confidential.

2. I agree to abide by the mission and structure of The Caring Cupboard.

By signing below, I acknowledge that I have read and understood the above statements, as they apply to volunteering at T

he Caring Cupboard. _______________________________________________ ________________________________________

Signature Date Shift Preferences:

Weekly or Bi-Weekly Client Shopping Hours Food Drop Off Hours/Receiving Area Kitchen Other: __________________________________

Days/Times of Availability:

Monday 9 – 11 a.m.

Monday 3 – 6 p.m.

Wednesday 9 a.m. – 11:30 a.m.

Wednesday 5:30 – 7:00 p.m.

Friday 8 – 10 a.m.

Friday 12 – 2 p.m.

 

Name *
Name