Registered Volunteer Application
First Name
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Zip Code
Primary Phone Number
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Gender
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Male
Female
Birthday
Emergency Contact Name
Emergency Contact Phone
How did you hear about volunteering?
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Facebook
Family/Friend
Flyer(s)
Facility employee
TV/Newspaper/Billboard/Ad
Internet
Other
Who did you hear about volunteering from?
Facility you would like to volunteer at
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Bluegrass
Bluffton
Bordeaux
Bowling Green
Bracken County
Bremen
Brookwood
Buckhead
Carrollton
Chapel Hill
Chautauqua
Chesapeake (Bayside)
Chillicothe
Clarksville
Cleveland
Clinton County
College Park
Colonial
Coshocton
Courtyard
Danville
East Louisville
Elizabethton (Pine Ridge)
Elizabethtown
Erin
Fayette County
Fentress
Fort Wayne
Fountain Circle
Galion
Georgetown
Glasgow
Golfcrest
Golfview
Greeneville
Gulfport
Harriman
Harrodsburg
Hart County
Hartford
Heritage Hall
Heritage Park
Hillcrest
Jackson Manor
Jacksonville
Jefferson Manor
Jefferson Place
Kenilworth
Kinston
Lafayette
Lee County
Liberty
Madison (Larkin Springs)
Mallard Bay
Marietta
Mayfair Manor
McCreary County
Memphis
Middleburg
Monroe County
Monteagle
Morgantown
Mountain City
Muncie
Newburgh
Norfolk (Harbour Pointe)
North Florida
North Hardin
Oakview
Orange Park
Ormond
Owensboro (Hermitage)
Palm Beach
Parkwood
Peninsula (Tarpon)
Pickett
Pigeon Forge
Port Charlotte
Portland (Highland)
Prestonsburg
Primacy
Princeton
Putnam County (Cookevlle)
Ridgely
Riverside (Calhoun)
Riverview
Roanoke Rapids
Rockcastle
Rockford
Rockwood
Rogersville
Savannah
South Bend
South Louisville
South Pittsburg
Southern Pines
Spencer County
Spring City
Standing Stone
Sts. Mary & Elizabeth
Summerfield
Summit Manor
Sunrise Manor
Surrey Place
Tanbark
Terre Haute
Tower Road
Warren
Washington
Waterford
Westmoreland
Whitesburg
Would you like a tour of our building and introductions to our staff?
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Yes
No
Areas of Interest
- Hold the Control key down to select multiple Areas of Interest.
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Art
Assist with Arts & Crafts
Assist with Birthday Parties
Bible Study Leadership
Building Decorations
Card and Letter Ministry
Chaperone a Quality of Life Event
Companionship (in public setting)
Dance
End of Life Volunteering
Garden Club
Holiday and Special Event Ministry Teams
Lead Game Activities
Letter Writing
Mail Delivery
Men and Women's Group
Ministry Internships in Chaplaincy
Music
Music Leadership for Worship
Nail Painting
One to One Ministry Visits
One-on-One Resident Interaction
Other
Painting Class
Palliative Care/ Simple Pleasures Cart
Pastoral Leadership for Church Services
Pet Visits
Prayer Group Leader
Prayer Walking
Reading and Story Time
Storytelling
Theater
Time Slips: Story Telling
Worship Through Art Leadership
Writing
List any Hobbies that interest you
List any Skills/Talents
Do you have transportation?
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Yes
No
When can you start?
Contact Information