Volunteer Application
Contact Information
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Phone
*
Please enter a valid phone number.
Cell Phone
*
Please enter a valid phone number.
Email
*
example@example.com
I am:
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Under the age of 18
Over the age of 18
Availability
During which hours are you available for volunteer assignments?
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Weekday mornings
Weekday afternoons
Weekday evenings
Weekend mornings
Weekend afternoons
Weekend evenings
Interests
Please check areas you would have an interest in volunteering.
Gunnison Valley Health Hospital
Greeting and patient escort
Senior Care Center
Help with resident outings
One-on-one time with residents
Help residents with exercise and range of motion activities
Wellness activities with residents
Arts and crafts and resident entertainment
Help with Senior Care Center events
Other
Hospice
General Hospice Volunteer
Special Skills or Qualifications
Summarize special skills and qualifications you have acquired from employment, previous volunteer work or through other activities, including hobbies or sports.
*
Previous Volunteer Experience
Summarize your previous volunteer experience.
*
Person to Notify in Case of Emergency
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Phone
*
Please enter a valid phone number.
Cell Phone
*
Please enter a valid phone number.
Email
*
example@example.com
Agreement and Signature
By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a volunteer, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal.
Signature
*
Date
*
-
Month
-
Day
Year
Date
Submit
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