Volunteer Application Name* First Last Phone Number*Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Current Employer*Employer Phone Number*Special Skills, Hobbies, or Interests*Have you ever done volunteer work before?* Yes No Where did you volunteer and what were your duties?*What led you to contact Skaalen regarding volunteer service?*Have you worked with mature adults before?* Yes No In what capacity?*What type of a commitment are you willing/able to make?* Weekly Twice a month Monthly Hours you are available to volunteer:* 9:15 AM - 11:15 AM 1:15 PM - 3:15 PM 5:30 PM - 7:00 PM Days you are available to volunteer:* Monday Tuesday Wednesday Thursday Friday Saturday Sunday Additional comments you have have regarding the times you are available to volunteer:Please check the areas in which you are most interested:* One-to-one visits with residents (conversation, reading) Resident mobility from their rooms to scheduled activities Substitute organist or worship service usher Reading to the visually impaired or assisting with letter writing Special occasions/holidays Clerical assistance Assist with games, parties or other scheduled events Assist with resident outings (shopping, meals, bus rides, etc...) Kaffe Stue Kitchen and Gift Shop volunteer (Monday-Friday; 11:00 AM - 1:00 PM or 1:00 PM - 3:00 PM) Crafts (Monday, Tuesday, Wednesday, and Friday; 9:15 AM - 11:00 AM) In case of an emergency, who would you like us to contact?Emergency Contact Name* First Last Relationship to Emergency Contact:*Emergency Contact Phone* Δ
