Student Volunteer Application Form

Episcopal SeniorLife Communities

Episcopal Church Home | Brentland Woods
River Edge Manor | Seabury Woods

Name:

Address:

City:

Zip:

Home Phone:

Cell Phone:

Birth Month / Day:

(VOLUNTEERS at Episcopal SeniorLife Communities MUST BE AT LEAST 14 YEARS OF AGE)

School Attending:

Grade:

Do you need to complete community service hours?

Yes

If so, how many hours are needed?

Due date of service hours:

Are you interested in volunteering after your community service is complete?

Once a week

A few times a month

For special events

Email:

Volunteer Experience:

Employment Experience:

Special Skills or Training:

Volunteer Job Preferred (See opportunities sheet):

Availability:

Days

Evening

Weekends

Time Preference :

EMERGENCY CONTACT INFORMATION

Name:

Home Phone:

Address:

Business Phone:

Relationship:

REFERENCES (Two people, not relatives, we may contact such as guidance counselor, teacher, pastor)

Name:

Home Phone:

Address:

Business Phone:

Name:

Home Phone:

Address:

Business Phone:

All students volunteering at Episcopal SeniorLife Communities will need to attend a facility orientation, provide proof of immunity to measles, mumps, and rubella and receive a tuberculin skin test (which we will provide on site, free of charge) prior to beginning your volunteer experience.

I authorize Episcopal SeniorLife Communities to verify the accuracy of information provided on this application and to obtain reference information. I hereby release Episcopal SeniorLife Communities, and any party supplying references, from any liability for a placement decision based on such information.

Please sign this application by typing your name below.

Applicant Signature:

Date:

I give permission to volunteer at ECH and to receive a health assessment as well as a Tuberculin Skin Test.

Signature of Parent/Guardian
(If student is under 18 years old):

Date:

Click here to submit this application.