Senior and Assisted Living Volunteering Opportunities

Youth Volunteer

* Required

(Volunteers at Episcopal SeniorLife Communities must be at least 14 years of age)

First Name:*

Middle Initial:

Last Name:*

Address:*

City:*

State:*

Zip:*

Preferred Phone:*

Alternate Phone:

Email:

School Attending:*

Grade:*

Do you need to complete community service hours?*
 Yes No

If so, how many hours are needed?

Due date of service hours:

Volunteer Experience:

Employment Experience:

Special Skills or Training:

Are you interested in volunteering after your community service is complete?
 Once a week A few times a month For special events

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

Volunteer Job Preferred:

Availability & Frequency:
 Days Evenings Weekends

Time Preference:

Emergency Contact Information

First Name:*

Middle Initial:

Last Name:*

Address:*

City:*

State:*

Zip:*

Preferred Phone:*

Alternate Phone:

Relationship:

Professional References

(Two individuals who can speak to your character, reputation, and work experience).

First Name:*

Middle Initial:

Last Name:*

Address:

City:

State:

Zip:

Preferred Phone:*

Alternate Phone:

Reference #2

First Name:*

Middle Initial:

Last Name:*

Address:

City:

State:

Zip:

Preferred Phone:*

Alternate 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 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.

Signature:*

Date:*

Parent Signature:

I give permission to my son or daughter:
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:*