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:

I understand that, if I am accepted as a volunteer with Episcopal SeniorLife Communities, I will be expected to observe confidentiality with respect to all information regarding my interactions with residents, staff, and family members at ESLC and any knowledge of the contents of confidential records. Failure to adhere to this agreement is ground for immediate dismissal.

Click here to submit this application.