Volunteer Application - Group Group/Organization Information Group/Organization Name * Official Representative Name * First Last * LastAddress Address Address Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Home Phone Work Phone Cell Phone Email * Alternate Contact Name * First Last * Last Group Size Age Range Grade(s) On-site Adult Supervisor Objective Community Service Special Project Education OtherOtherCommitment 1-2 hours 1/2 Day 1 Day Several Days Weekly Monthly Days available Monday Tuesday Wednesday Thursday Friday Saturday SundayTimes available Mornings Afternoons Evenings Weekends Specific Date(s) Specific Time(s) Please check off any of the areas below that interest you.(Jewish Nursing Home = JNH; Ruth’s House Assisted Living = RH; Adult Day Health = WADH)Interests Recreation Activities Assistance (JNH/RH)Bingo, Arts &Crafts, Spelling Bee, Board GamesDiscussion GroupsComputer classMusic programsBridge/Mah JongDay Trips Coffee Shop (JNH) Religious Services (JNH) (Fri. 3:30 PM/Sat. 9 AM) Adult Day Care Assist (WADH) Caring Friend (JNH/RH) Library Cart (JNH/RH) Administrative Assistance (JNH/RH) Transporting Residents w/i JNH/RH Monthly Birthday Parties (JNH) Monthly Summer Picnics (JNH) Cafeteria Assistance – Cashier (JNH) Gift Shop (JNH) Special skills, interests, hobbies, languages, talents (music/dance/art) you would like to share with resident: Please list any special accommodations you may need. Signature * By checking this box, I confirm that this checkbox serves as my electronic signature. Captcha If you are human, leave this field blank. Submit
