Name of Group*
Contact First Name:*
Contact Middle Initial:
Contact Last Name:*
Email address of contact at organization:
Special Skills or Training:
Select community you wish to serve (check all that apply):
Beatrice Place Brentland Woods Center for Rehabilitation The Episcopal Church Home Pinehurst River Edge Manor Rockwood Center Seabury Woods Valley Manor Multiple Sites No Preference
Availability & Frequency:
One Time Weekly Monthly
Volunteer Job Preferred:
Fill in times below:
* 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 party supplying references, from any liability for a placement decision based on such information.
* 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 grounds for immediate dismissal.
Please sign this application by typing your name below.
505 Mount Hope Avenue
Rochester, NY 14620
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