Mission Statement

    We support area neighbors 60 years of age and older to continue living
    independently in the home of their choice through community volunteerism.

    Vision Statement

    By working together, the aging neighbors of our
    community will live longer, happier, and meaningful lives.

    Volunteer Application

    Your Name
    Birthdate (mm/dd/yyyy)
    Day Phone
    Evening Phone
    Cell Phone

    Emergency Contacts

    Relationship: SpouseFriendFamilyOther

    Relationship: SpouseFriendFamilyOther

    Are you a veteran YesNo
    Is your spouse a veteran YesNo
    Religious Affiliation

    Work Experience

    Volunteer Opportunities
    (Please check all areas of interest)

    Provide Services to Clients: Transportation/RidesYardworkRespite CareMinor Home Repair/ModificationArt ClassesHomemaking/ChoresFriendly VisitingFood ProgramsHome DeliveriesSenior SocialGrocery ShoppingFriendly Phone CallsSnow RemovalHealth & Safety Ed.Physical Fitness

    Fundraising/Office/Board Opportunities: Pork Chop DinnerSilent AuctionFundraising CommitteeBoard of DirectorsGolf TournamentTouching TablesFinance CommitteeNewsletterOffice AssistanceFoley Fun DaysCommunications CommitteeOther

    If Other checked please specify:

    As a CARE volunteer, you will set your own schedule, and provide services according to your passions and interests, as often as you choose.

    How far are you willing to drive to serve a client?

    How did you learn about the CARE program? CARE websiteCARE Facebook pageCARE Connections newsletterCARE Community PresentationFriend/Family MemberLocal newspaperCommunity EventMedical ProfessionalBenton CountyOther

    If Other checked please specify:

    List of References

    (Please list 3 references)

    Name / Relationship / Phone / Best Time to Contact




    Volunteer Background/Publicity/Special Accommodations/Signature Agreements

    I hereby authorize CARE - Community Action Respecting Elders to contact my references and to conduct a routine BCA background check. The information that I have provided in this application is true and correct to the best of my knowledge. YesNo
    Initials: Date:

    I hereby give CARE - Community Action Respecting Elders permission to use my name and photograph to promote the CARE program. This permission includes publicity, fundraising campaigns, and sharing photographs with other media for these purposes.YesNo

    Do you require any special accommodation from CARE - Community Action Respecting Elders to perform the volunteer responsibilities as outlined in the orientation material?
    If YES, what special accommodation do you require?

    If I am selected to participate in the CARE program, I understand and agree to adhere to the volunteer policies and procedures as presented to me by the administrators of the CARE - Community Action Respecting Elders.