Mission Statement
Emergency Contacts
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
As a CARE volunteer, you will set your own schedule, and provide services according to your passions and interests, as often as you choose.
List of References
(Please list 3 references)
Name / Relationship / Phone / Best Time to Contact 1. 2. 3.
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?YesNo 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.
Signature: Date:
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