Volunteer Information Form

If you are interested in becoming a volunteer or have any questions about the volunteer program, please complete the form below. The Life Enrichment Coordinator will contact you in a timely manner.

"*" indicates required fields

Name: *

First Last

Address: *

Street Address Address Line 2 City State ZIP Code

Phone: *

Email: *

Emergency Contact: *

First Last

Emergency Contact Phone: *

Emergency Contact Relationship:

Affiliated School/Company/Church/Organization:

Why do you wish to volunteer? Please check all that apply:

Desire for serving others

For School Project

Required Hours for School

Required Community Service Hours

Prior Volunteer Experiences:

Personal Skills/Talents:

Time/Event Availability:

Desired Volunteer Activities:

Are you under the age of 16? *

Yes

If potential volunteer is under the age of 16, parent approval and accompaniment during volunteer time is required. Have parent or guardian complete section below:

I, the parent/guardian of the volunteer signing up, authorize them to volunteer his/her time and services at your facility. *

I agree

Parent/Guardian Name:

First Last

Parent/Guardian Phone:

All potential volunteers must be interviewed by Life Enrichment and complete screenings before being assigned to complete orientation and/or beginning volunteer duties.

Volunteer Information Form

Vetter Senior Living Careers

Contact Heritage of Emerson