Volunteer Application

Your Name (required)

Address (required)

Phone (required)

Email (required)

Birth Date

Why do you want to volunteer for Living Branches? (If for a school project, please include the number of hours needed and due date.)

Hobbies / Interests / Skills:

Emergency Contact

Emergency Contact Name (required)

Address (required)

Emergency Contact Relationship

Volunteer Information

Volunteer Opportunities - check all that interest you
QuiltingBed makingGift/thrift shop (min 16 yrs)Wheelchair transportMeal assistant (min 16 yrs)Audio/visualOne on one visitsProgram assistantMusic (instrumental/vocal)Giving fresh waterSpiritual supportFundraising/special eventsPlant care (indoor/outdoor)Pet therapyChild care (Dock Woods only - min 16 yrs)Other

Availability - check days of the week
MondayTuesdayWednesdayThursdayFridaySaturdaySunday

Availability - please provide any additional information regarding what hours you are available

Preferred Campus - check all that apply
The Willows (formerly Dock Meadows)Souderton Mennonite HomesDock Woods

Preferred Area of Service - check all that apply
Residential LivingPersonal CareHealth CareMemory Care

References - list two non-family members we may contact with reference to your application

Reference #1 Name (required)

Reference #1 Phone (required)

Reference #1 Relationship (required)

Reference #2 Name (required)

Reference #2 Phone (required)

Reference #2 Relationship (required)

Personal History

Previous Volunteer Experience - please list location, dates, and duties

Previous Work Experience - please list employer, dates, and duties

Do you hold any degrees or certifications?
yesno

If yes, what are they?

Have you ever served in any of the US Armed Forces?
yesno

If yes, please list which branch and the dates of service.

Photo Release - Living Branches occasionally takes photos of its volunteers to use for marketing, website, or other internal and external media materials. Please check one:
I give my permission to allow Living Branches to take photos of me while volunteering and to use as described above.I do not give my permission to allow Living Branches to take photos of me while volunteering and do not give permission to use them as described above.

Please read the following statement carefully before signing this application:

I understand that this is an application for and not a commitment or promise to provide an opportunity to volunteer. I further understand that by submitting this application I am consenting to the completion of a criminal background check made by Living Branches on my behalf and that this check will be made from governmental sources. I hereby agree to release and hold harmless from liability any person or organization that provides information to Living Branches. I certify that I have and will provide information throughout the selection process, including on this application for a volunteer position and interviews with Living Branches that is true, correct and complete to the best of my ability and that I have not and will not withhold any information that would unfavorably affect my application for a volunteer position. I understand that information contained on my application will be verified by Living Branches. I understand that misrepresentations or omissions may be cause for my immediate rejection as an applicant for a volunteer position with Living Branches or termination as a volunteer.

Signature of Applicant

Date

Parent/Guardian Signature (if applicant is under 16 years of age)