Colonial Club
Volunteer Information  Form
 
Name    
Street Address   
Address (cont.)   
City   
State/Province   
Zip/Postal Code   
Home Phone   
Work Phone   
E-mail address  
Educational Background  
Current/Former Occupation  
Hobbies/Interests/Activities in which you participate  
Volunteer Experience  
How did you find out about our need for volunteers?  
Why do you wish to volunteer?  
What type of commitment are you willing to make?  
  Weekly  Twice/Monthly  Once/Monthly  Occasionally

 Days and Hours available to work

 
Check and special skills you have, and areas of volunteer work in which you may be interested Accounting/Bookkeeping
Adult Day Center activities
Blood pressure nurse/receptionist
Board committees
Computer knowledge/training
Craft/hobby instructor
Crafts/Sewing
Driver
Entertainer/speaker/presenter
Events planning/assisting
Faith and Friends
Filing
Fundraising
Gardening
Gift Shop
Home delivered meals driver		 Home repairs/snow shoveling
Intergenerational programs
Mailings/newsletter
Meal host/hostess
Music (chorus/chimes/instrumentalist)
Nutrition site helper
One-on-one visiting
Photo albums of Colonial Club events
Receptionist
Refreshments/baker
StrawberryFest assistance
Typing/data entry
Trips committee
Videotaper
Woodworking
Writing/editing
Please list any special skills or services you would like to offer
Have you ever been arrested or convicted for a crime?
Yes No
If yes to the above, please explain
Information needed for background record check
Social Security Number

Birth Date
Male Female
Volunteer drivers, please answer yes or no


 		  
Do you have a valid driver's license?       Yes No

Chauffeur's license?                                Yes No

Valid car insurance?                                Yes No
References (list two);  Indicate if work or personal reference

Reference #1

 

Reference #2

  

 

Name
Personal Work  Phone Number

Name
Personal Work  Phone Number

Volunteer Release Form

I understand my services are being offered on a voluntary basis without anticipation of financial remuneration.  I shall indemnify and hold harmless the Colonial Club Senior Activity Center and employees from and against all claims, demands, loss of liability of any kind or nature for any possible injury incurred during volunteer service.

I understand the Colonial Club Senior Activity Center may require a police/background check.  I grant my permission for such a check.

I understand that volunteers are responsible for maintaining the confidentiality of all privileged information to which they may be exposed while serving as a volunteer.  This information may include personal information about staff, participants, and other volunteers or overall agency business.

Type the signature of the volunteer here  Date

Type the signature of Parent/Guardian (if volunteer is under 18) here
    Date 
 
Copyright © 2006 [Colonial Club]. All rights reserved.
Revised: 11/04/07