Volunteer Application Personal InformationName* First Middle Initial Last Address City Zip Date of Birth* MM slash DD slash YYYY Email* Phone*How did you hear about Meals on Wheels? Are you volunteering to fulfill court-ordered community service hours?* Yes No Emergency Contact Name* Emergency Contact Phone* Emergency Contact Relationship* Physical limitations: Yes No Please describe your physical limitations: For demographic reporting purposes onlyGender Male Female RaceWhiteBlackHispanicHawaiian / Pacific IslanderNative AmericanInterestsLocation Preference* Central Kitchen (2900 Wilson Ave SW, Grandville) Administrative office (2900 Wilson Ave SW, Grandville) Delivery/distribution (2900 Wilson Ave SW, Grandville) Pantry (1954 Fuller NE, Grand Rapids) Areas of Interest: First ChoicePlease choose oneKitchen-Meal assembly/ food packagingDelivery- Delivering meals to clients (Delivery days are M,W, & F)Pantry- Stocking shelves, carrying out groceries, repacking foodOffice- Various clerical dutiesCreative- Decorating bags or card creationSanta to a Senior Gift DeliveryRemote Opportunity - Well-Being Calls to ClientsOtherAreas of Interest: Second ChoicePlease choose oneKitchen-Meal assembly/ food packagingDelivery- Delivering meals to clients (Delivery days are M,W, & F)Pantry- Stocking shelves, carrying out groceries, repacking foodOffice- Various clerical dutiesCreative- Decorating bags or card creationSanta to a Senior Gift DeliveryRemote Opportunity - Well-Being Calls to ClientsOtherAreas of Interest: Third ChoicePlease choose oneKitchen-Meal assembly/ food packagingDelivery- Delivering meals to clients (Delivery days are M,W, & F)Pantry- Stocking shelves, carrying out groceries, repacking foodOffice- Various clerical dutiesCreative- Decorating bags or card creationSanta to a Senior Gift DeliveryRemote Opportunity - Well-Being Calls to ClientsOtherHow often are you interested in volunteering?*1x week1x per monthbi-monthlyone time opportunityotherHow many hours a week would you like to volunteer? AvailabilityCheck all that apply. Monday Tuesday Wednesday Thursday Friday What times are you available?Check all that apply. Morning 8:30-11:00 Afternoon 11:00-3:30 Flexible Why do you want to volunteer for Meals on Wheels? Resume building Job experience Volunteer hours Fill extra time Give back HiddenPlease describe any prior volunteer experience: HiddenDo you have any special skills, training, or experience that would be helpful?FundraisingForeign languageComputer knowledgeWebsite designLeadership skillsOtherHiddenReferencesPlease list two personal references not related to you.HiddenName HiddenRelationship HiddenPhoneHiddenName HiddenRelationship HiddenPhoneVolunteer Liability WaiverAs a volunteer for the Senior Meals Program Inc. (SMP), I acknowledge and agree to the following: * I will not receive any monetary compensation for my services and I will not accept any compensation or other form of remuneration from any SMP clients. Client information is strictly confidential and I will not discuss client or agency information with any other person or entity. I will accept the supervision of the staff I am assigned to and I will discontinue my service if I am requested to do so by the organization. I agree to hold harmless and hereby indemnify Senior Meals Program, Inc. if through the course of my volunteer work I am injured, become ill and/or require medical treatment. I hereby waive any claim, known or unknown, against Senior Meals Program, Inc., its officers, directors and/or employees resulting from such circumstances. Permission for Criminal Records Check* I give permission to the Senior Meals Program Inc. to conduct a criminal background check on any past or present criminal convictions. I understand that this records check may include convictions in the State of Michigan or any other state. I also understand that this is a State of Michigan Office of Services to the Aging requirement, in order to be a volunteer at SMP and that the Senior Meals Program has discretion, based on results to not accept me as a volunteer for the safety of their clients. Photo Release I hereby authorize and give consent to the Senior Meals Program, Inc. to copyright, publish, or use in publications, brochures, or social media, any photographs taken of myself without expectation of compensation. Communication Preferences Please add me to the Meals on Wheels Western Michigan email list Please add me to the Meals on Wheels Western Michigan mailing list
