Make an impact today Support our vision of people living full lives with faith, passion, and purpose by volunteering. Name * First Name Last Name Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Email * Birthday MM DD YYYY Emergency Contact * Who referred you, or how did you hear about Friendship Haven? Employment Current place of employment or work setting before retirement Position How long have you worked there? What are your regular work hours? Experience, skills, and interests Volunteer experience Hobbies & interests Talents, skills, & abilities Community affiliations/organizations you are a member of Do you speak, read, or write another language? Yes No If so, which? Why do you want to volunteer? What type of volunteer work are you willing to do? Please check all that apply. Anything. I'm flexible. Coffee host/hostess Activities assistance Clerical/computer Off-site trips Therapy transportation (restorative assistant) Pet visits Reading to visually impaired Baking/cooking Special events & projects Walking/escort/transportation assistance Tutor/basic computer Visiting Games/cards Shopping trips Entertainment (a special talent you'd like to share) Other (please list below) List other here Availability (Please check all that apply.) Days of the week Monday Tuesday Wednesday Thursday Friday Saturday Sunday Times of day Mornings Afternoons Evenings Times of year Winter Summer Seasonal (specify below) Other (specify below) How long do you plan to volunteer? Anything else you'd like to specify? Sign If accepted as a Friendship Haven volunteer (please check all): * I voluntarily offer my services with a clear understanding there will be no monetary compensation. I agree to conform to all policies, procedures, and regulations. I will satisfy any needed health and screening requirements. If requested, I will submit references and/or appropriate school documentation. I certify that the information contained in this application is correct to the best of my knowledge. I understand that Friendship Haven takes confidentiality of our residents’ medical and personal information, along with our employees’ personal and medical information, very seriously. As a volunteer, I may overhear or be privy to information that is meant only for the care of the resident or participant and not as information to be shared with others. I understand that volunteer service is at the sole discretion of Friendship Haven and that Friendship Haven may terminate the volunteer’s relationship with the organization at any time, for whatever reason. Electronic signature * First Name Last Name Date * MM DD YYYY Thank you!
