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Volunteer Interest Information

 

Name:   

Address:   

City:   

State:   

  Zip Code:

Home Phone:   

Work Phone:

Email Address:   

 

Previous volunteer experience:
Duties performed:
Religious/Club affiliations:

 
Certified in CPR? Yes No If no,willing to take training? Yes No

Do you have reliable transportation?

 

Areas/Types of Volunteer Work in which you are interested:

Providing Meals Special Events Housekeeping
Exercise/Movement Laundry Arts and Crafts
Lawn Maintenance Reading Home Repair
Music/Singing Transportation Friendly Visitor
Run errands Office Work Cards/Games
Massage Special Programs
(sing-alongs, plays, etc.)		 Fundraising Projects

 

Do you have skills/hobbies/interests you would like to share?
Reason for volunteering?
Are you willing to be trained?


Which days are you available?

Mon Tue Wed Thurs Fri Sat Sun
Hours: Morning Afternoon Evenings

Time limit of commitment?

Do you have any questions or concerns?

 

When would be the best time to contact you?

  

                        
 
 

©2005 House of Care
515 West Beaver Avenue
State College, PA 16801
814-237-5517

Email: House of Care