Name

Email Address

Address

City

State

Zip Code

Phone

What is the best time to contact you?

Areas of Interest: (select all that apply) Areas of Interest: (select all that apply) Administrative: Front Desk (phones, greeting visitors), filing, data entry, typing, etc. Telephone Outreach: Calling older adults to check-in on them, and any needs they may have. Food Distribution: Monthly assistance distributing food to eligible seniors. Recreation: Planning, assisting during event/activity, set-up, cooking, etc. Events: Fund-raisers and services. Other: Membership, Nutrition, Board or Advisory committee, craftsman or trade volunteers, in need of community service hours.

Do you have any skills, hobbies, or interests to share with us?

Preferred Days to Volunteer: (select all that apply) Preferred Days to Volunteer: (select all that apply) Sunday Monday Tuesday Wednesday Thursday Friday Saturday

What date would you like to begin?

Will you need any particular accommodations to perform your volunteer duties? If yes, please describe them here.