Get Rockville Nursing Home Volunteer Application

ROCKVILLE NURSING HOME VOLUNTEER APPLICATION Thank you for your interest in Rockville Nursing Home s Volunteer Program. Most of our volunteers work directly with our residents. There are occasionally some opportunities to assist with mailings and other similar tasks. After filling out this application please return it to the front office. The Volunteer Coordinator will contact you once your application has been processed* Today s Date How did you hear about our program Contact Information Name please print Phone list at least one Home Cell/Work Address Street Apt. City State Zip All About You Please list your age if you are under 20 years old Special skills hobbies languages etc* Past volunteer experience Past experience with the elderly Emergency Contact Name Relationship Phone Are you volunteering to complete Community Service Hours Yes No If yes how many hours do you need in total By what date are the hours required to be completed For what purpose are you required to perform community service Court mandated community service positions are not available. School Service Club/Organization Other Please check the volunteer opportunities you may be interested in Group Programs Arts Crafts Sing Along Gardening Parties Religious Fitness One to One / Small Group Interactions Friendly Visits Letter Writing Reminiscing Reading Manicures Board Games Games Current Events Reading Groups Trivia Sensory Stimulation Independent Musical Performance Educational Talks Leading Resident Groups Men s Club Current Events Sewing Group etc* What kind of group would you like to lead Please check off your times of availability on the chart. How frequently are you planning to volunteer Just this once Daily Several times a week Once a week Once a month Mornings Afternoons Evenings Monday Tuesday Wednesday Thursday Friday Saturday Sunday Please Sign Here. There are occasionally some opportunities to assist with mailings and other similar tasks. After filling out this application please return it to the front office. The Volunteer Coordinator will contact you once your application has been processed* Today s Date How did you hear about our program Contact Information Name please print Phone list at least one Home Cell/Work Address Street Apt. The Volunteer Coordinator will contact you once your application has been processed* Today s Date How did you hear about our program Contact Information Name please print Phone list at least one Home Cell/Work Address Street Apt. City State Zip All About You Please list your age if you are under 20 years old Special skills hobbies languages etc* Past volunteer experience Past experience with the elderly Emergency Contact Name Relationship Phone Are you volunteering to complete Community Service Hours Yes No If yes how many hours do you need in total By what date are the hours required to be completed For what purpose are you required to perform community service Court mandated community service positions are not available. City State Zip All About You Please list your age if you are under 20 years old Special skills hobbies languages etc* Past volunteer experience Past experience with the elderly Emergency Contact Name Relationship Phone Are you volunteering to complete Community Service Hours Yes No If yes how many hours do you need in total By what date are the hours required to be completed For what purpose are you required to perform community service Court mandated community service positions are not available. School Service Club/Organization Other Please check the volunteer opportunities you may be interested in Group Programs Arts Crafts Sing Along Gardening Parties Religious Fitness One to One / Small Group Interactions Friendly Visits Letter Writing Reminiscing Reading Manicures Board Games Games Current Events Reading Groups Trivia Sensory Stimulation Independent Musical Performance Educational Talks Leading Resident Groups Men s Club Current Events Sewing Group etc* What kind of group would you like to lead Please check off your times of availability on the chart. .