Volunteer Interest Form

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Email

I would like to:

Check all that apply.

Make phone calls and/or visit homebound members.

Drive and accompany a member to a medical appointment.

Organize a party or an outing.

Assist with small tasks and errands

Help with minor household repairs.

Assist a member with computer tasks.

Write for our monthly newsletter.

Help raise funds for At Home.

Consider joining our board.

Message

By submitting this form, the signer agrees to the following: 1. Perform the volunteer services here-in applied for unless s/he finds it impossible to continue and therefore communicates this to At Home; 2. Consent to a criminal background check and DMV check as applicable; and 3. All information about member(s) is confidential.