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Volunteer Application
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Last Name:
Address:
Address (Cont.):
City:
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Zip:
Date of Birth:
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Cell Phone:
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Email:
In an emergency please contact:
Emergency Contact Phone:
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Location Preference:
Parker at Landing Lane (New Brunswick):
Yes
No
Parker at Monroe (Monroe Township):
Yes
No
Parker at River Road (Piscataway):
Yes
No
Parker at Stonegate (Highland Park):
Yes
No
Parker at McCarrick (Somerset):
Yes
No
Pavilion (Highland Park):
Yes
No
Previous volunteer experience:
Specific needs related to this volunteer experience:
Preferences:
Resident/Participant engagement:
Rehabilitation:
Administrative/Clerical:
Pet Visits/Therapy:
Other:
Please indicate your availability and timeframe:
(example 12pm - 3pm)
Monday:
Tuesday:
Wednesday:
Thursday:
Friday:
Saturday:
Sunday:
How often would you like to volunteer?
Once a week:
Once every other week:
Once a month:
Other:
Please indicate your interests, talents and hobbies:
Discussion Group:
Arts and Craft:
Bible Study:
Bingo:
Bridge/Pinochle/Blackjack/Poker:
Board games/Crossword puzzles:
Reading, writing, poetry:
Clerical/computer:
Music/singing:
Cooking:
Crocheting/Knitting:
Exercise:
Dance:
Art History:
Science:
Trips/travel:
Walking:
Visiting:
Do you play an instrument:
Yes
No
If yes what type?:
Would you be available for special events on occasional basis?:
Yes
No
Have you ever worked with people who have dementia?:
Yes
No
Do you prefer:
One-on-one interactions:
Small group activities:
Large group activities:
References:
First Name:
Last Name:
Phone Number:
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)
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Second three digits
Last four digits
Address:
Address (Cont.):
City:
State:
Zip:
First Name:
Last Name:
Phone Number:
(
)
-
Second three digits
Last four digits
Address:
Address (Cont.):
City:
State:
Zip:
Additional comments/needs:
Parker Awards