Lake Wales Care Center
Volunteer Information Sheet – Please complete front & back
Birthdate ______Today’s Date ______
Month/Day/Year
Name ______
Parent Name (If applicant is under 18/living at home)______
Local Address ______
City______State ______Zip ______Phone ______
Email:______Local Church Affiliation ______
Age Range: [ ] 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: Morning Afternoon Thursday: Morning Afternoon
Tuesday: Morning Afternoon Friday: Morning Afternoon
Wednesday: Morning Afternoon Saturday: Morning Afternoon
other ______
Have you ever been involved in the past with Lake Wales Care Center? 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
01/15
OPPORTUNITIES TO SERVE
Please check all areas of service that interest you
[ ] 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
[ ] Meals-on-Wheels
One day per week, 2 hours delivering noon meals to area shut-ins.
[ ] Light Housekeeping
Provide basic cleaning tasks for the elderly, disabled, and shut-ins.
[ ] Records and Reports
Tasks include record keeping and/or computer entry.
[ ] Food Room
Receive food, stock shelves and pre-pack boxes for deliveries.
[ ] Surplus Sales - Thrift Store
Sort donated items, restock merchandise, and assist customers.
[ ] Furniture Pickups & Deliveries
[ ] General Maintenance
Assisting with building and equipment maintenance.
[ ] Home Visitation & Follow-up Calls
May include food deliveries and/or follow-up encouragement visits.
[ ] Transportation [ ] Local only [ ] Willing to travel out of town
Provide transportation for area shut-ins to the store or special appointments.
[ ] Home Repair Projects
Minor home repairs, chaperon at summer camp, minor home repair. List skills ______
[ ] Holiday Assistance
Prepare and deliver food baskets and toys
[ ] Transitional Housing
Groups, families, or individuals may adopt a unit, perform yard work, or mentor a family
[ ] 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. ______
______
[ ] Literacy Tutoring
Tutoring-one on one and in small groups, Adult Literacy, ESOL Classes.
[ ] Free Health Clinic-receptionist, qualifying patients, medical professional.
Please return this form to Care Center. 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.