Volunteer Application - Meals on Wheels of Western Michigan

Personal Information

Name*

First Middle Initial Last

Address

City

Zip

Date of Birth*

Email*

Phone*

Maiden Name/Alias

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 only

Gender

Male
Female

Race

Interests

Location 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)
Dining Site (various locations in Kent County)
Fifth Third Riverbank Run (Downtown Grand Rapids, 5/12/18)

Areas of Interest: First Choice*

Areas of Interest: Second Choice*

Areas of Interest: Third Choice*

How often are you interested in volunteering?*

How many hours a week would you like to volunteer?

Availability*

Check 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

Please describe any prior volunteer experience:

Do you have any special skills, training, or experience that would be helpful?

References

Please list two personal references not related to you.

Name

Relationship

Phone

Name

Relationship

Phone

Volunteer Liability Waiver

As 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.

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.

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.