Lake Wales Care Center

Volunteer Information Sheet – Please complete front & back

Birthdate ______Today’sDate ______

Month/Day/Year

Name ______

Parent Name (If applicant is under 18/living at home)______

Mailing Address ______

City______State______Zip ______Phone ______

Email:______Local Church Affiliation ______

AgeRange: [ ] Youth [ ] 18-24 [ ] 25-45 [ ] 46-62 [ ] 63+

Service category (please check one)

_____ Volunteer_____ Required Community Service_____ Comm. Service for School Credit

Days and Time Available to Serve: circle those that apply

Monday: MorningAfternoonThursday: Morning Afternoon

Tuesday: Morning AfternoonFriday:Morning Afternoon

Wednesday: Morning AfternoonSaturday: Morning Afternoon

Other ______

Have you ever been involved in the past with LakeWalesCareCenter? If yes, explain ______

______

What is your motivation or interest in being a volunteer? ______

______

List abilities, talents or special skills you have to offer: ______

______

Please describe any physical limitations or special medical conditions: ______

______

If you are being required to volunteer for community service hours describe the nature of your offense, what

agency assigned the hours, how many hours you must perform, and to whom you will be reporting.

______

______

I,______, give my permission for Lake Wales Care Center to produce, print, and/or use my photograph for

promotional purposes of Lake Wales Care Center. ______

SIGNATURE DATE

03/17

OPPORTUNITIES TO SERVE

Please check all areas of service that interest you

[ ] Enterprise Programs - Thrift Stores, Online Sales, Christian Bookstore

Sort donated items, restock merchandise, and assist customers.

[ ] Meals-on-Wheels - One day per week, 2 hours delivering meals to area shut-ins.

[ ] Furniture Pickups & Deliveries -Assist drivers in daily pickup/delivery operations.

[ ] General Maintenance-Assisting with building and equipment maintenance.

[ ] Home Repair Projects - Minor home repairs

List skills ______

[ ]Transitional Housing - Groups, families, or individuals may adopt a housing unit or perform

yard work at housing unit

[ ]Front Office Receptionist - Receptionists work half-day shifts, usually one morning or afternoon

per week. Tasks include receiving guests & answering the phone.

[ ]Mailing Assistant - Assist with mailings, affix labels & tabs; stuff, seal and stamp envelopes

[ ] Records and Reports-Tasks include record keeping and/or computer entry.

[ ]Light Housekeeping - Provide basic cleaning tasks for the elderly, disabled, and shut-ins.

[ ] Food Room-Receive food, stock shelves and pre-pack boxes for deliveries.

[ ] Home Visitation & Follow-up Calls - May include food deliveries and/or follow-up

encouragement visits.

[ ] Transportation - Provide transportation for area shut-ins to the store or special appointments [ ] Local only [ ] Willing to travel out of town

[ ] Skills Training for Clients - Assist in teaching homemaking, work related skills, money

management, parenting, and other self-help skills.

Please list particular skills you could teach. ______

[ ] Holiday Assistance-Prepare and deliver food baskets and toys

[ ] Youth Programs-Chaperon at camp, mentor young people.

[ ] Community Garden-Mentor new gardeners

[ ] Literacy Tutoring - Tutoring-one on one and in small groups, Adult Literacy, ESOL Classes.

[ ] Free Health Clinic-receptionist, qualifying patients, medical professional.

[ ] Choices Pregnancy Care Program-client advocate, medical professional.

Please return this form to CareCenter. Thank you for your time and cooperation. Background screenings are a standard requirement for volunteer positions. We look forward to working with you. If other areas of community service may suit you better we also have a list of other local organizations that utilize volunteers.

03/17