Online Volunteer ApplicationPlease fill out the online Volunteer Application and press send to submit. We will be in touch with you. Name * First Name Last Name Email * Cell/Mobile * (###) ### #### Home Phone (###) ### #### Date of Birth * MM DD YYYY Are you vaccinated? * "Yes" constitutes at least two main shots and one booster. Yes No Mailing Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Interests Volunteer options Driver Reading Volunteer Opportunities (Please check any that you'd like to do.) Transportation Medical Appointments Bainbridge Island Kitsap County Seattle Non-medical appointments Willing to be called last minute Errands Grocery Shopping Delivering Flowers Telephoning Care (Phone Buddies) In-Home Care Companionship/Home Visits Respite Care Light Housekeeping Yard/Home Maintenance Pet Care Light Meal Prep Technology Assistance Life Enrichment Activities Taking a care receiver to concert, gallery, museum etc Going for a walk, or scenic drive, garden tour etc. Singing or listening to music Card or board games, puzzles Volunteer Administrative Opportunities Office Support Technology Support Fundraising/Auction Newsletter Photography/Video Marketing Previous Volunteer Experience General interests, skills, languages, hobbies, educational or work background that will help us make a good match. Do you smoke Yes No Willing to visit a smoker? Are you allergic to pets? Yes No Other allergies? Do you have any physical conditions that would limit your volunteer activities? If yes, please describe I could lift: Lightweight wheelchair (32 lbs) Standard wheelchair (46 lbs) Walker Neither Do you have a valid driver's license? Yes No Do you have current auto insurance? Yes No We will need copies of both your driver's license and your auto insurance. Emergency Contact References Please list two personal references we may contact who are not family members and who do not live in the same household as you. Have you ever been convicted for violation of any non-traffic laws? Yes No I hereby disclose that I have or have not ever been convicted of any crime against persons: Have Have not I hereby disclose that I have or have not ever been convicted of crimes relating tothe financial exploitation of any person. Have Have not I hereby disclose that I have or have not ever been found to have sexually or physically abused, assaulted or exploited any person. Have Have not I hereby authorize Island Volunteer Caregivers to request a background check by the WA State Patrol in support of the above disclosure, as well as a Driver's Abstract from the WA State Dept of Licensing, if I will be providing transportation. These will be done upon initial application, and at least biennially.
