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.
