Volunteer Application 1 Applicant Information 2 General Information3 Areas of Interest4 Hobbies/Skills 5 Availability Name* First Last Phone*Email* Birthday* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Emergency Contact Name*Emergency Contact Phone* Are you Part of a Group?*Please Choose Option BelowYesNoIf yes, what is your groups name?*What facility would you like to volunteer?*Please Choose Option BelowAnchorBloomsburgBluegrassBluftonBordeauxBowling GreenBracken CoBremenBrookwood GardensBuckheadCarrolltonChapel HillChautauquaChesapeake ShoresChillicotheClevelandClinton CountyCollege ParkColonialColumbiaCoshoctonClarksvilleCourtyardDanvilleEast LouisvilleElizabethtonElizabethtownErinFayetteFentressFort WayneFountain CircleGainesvilleGalionGastoniaGeorgetownGlasgowGolfcrestGolfviewGreenevilleGulfportHarrimanHarrodsburgHart CountyHartfordHeritage HallHeritage ParkHermitageHillcrestJackson ManorJacksonvilleJefferson ManorJefferson PlaceKenilworthKinstonLafayetteLee CountyLibertyMadisonMallard Bay/ Harbour PointeMariettaMayfair ManorMcCreary CoMemphisMethodistMonroe CountyMonteagleMorgantownMorgantownMuncieNewburghNorfolkNorth FloridaNorth HardinOakviewOrange ParkOrmondPalm BeachParkwoodPeninsulaPickettPigeon ForgePikevillePort CharlottePortlandPrestonburgPrimacyPutnam CoRidgelyRiversideRiverviewRoanokeRockcastleRockfordRockwoodRogersvilleSavannahSouth BendSouth LouisvilleSouth PittsburgSouthern PinesSpencer CoSpencer CountySpring CitySt. Mary & ElizabethSt. Peter VillaStanding StoneSummerfieldSummit ManorSunrise ManorSurrey PlaceTanbarkTerre HauteTower RoadTrimbleWarrenWashingtonWaterfordWestmorelandWhitesburg GardensWinter ParkWould you like a tour of our building and introductions to our staff?*Please Choose Option BelowYesNo What is your area of interest?* One-on-One Resident Interaction Building Decorations Assist with Arts & Crafts Men and Women's Group Chaperone a Quality of Life Event Reading and Story Time Lead Game Activities Pet Visits Letter Writing Assist with Birthday Parties Garden Club Prayer Group Leader Bible Study Leadership Music Leadership for Worship One to One Ministry Visits Card and Letter Ministry Holiday and Special Event Ministry Teams Worship Through Art Leadership Palliative Care/ Simple Pleasures Cart Ministry Internships in Chaplaincy Prayer Walking Pastoral Leadership for Church Services End of Life Volunteering Mail Delivery Nail Painting Painting Class Time Slips: I Won't Grow Up Art Music Dance Theater Storytelling Writing Companionship Other List any hobbies that interest you.*List any skills/talents* Do you have transportation?* Yes No When can you start?* What Day/Days are you interested in volunteering?*MondayTuesdayWednesdayThursdayFridaySaturdaySundayWhat Time of Day is Best for you?* Morning (9-12) Afternoon (12-3) Late Afternoon (3-5) Evening (5-7) Night (After 7) How Did You Hear About Us?* Website Newspaper Flyer Facebook Facility Word of Mouth UntitledFirst ChoiceSecond ChoiceThird Choice If you prefer to fill this application out on paper, please click here!