Please fill in all requested information and click the "Send" button at the bottom, and someone will contact you. Thank you so much for being willing to share your time and talents with us!

Name
Company Name (if applicable)
Address
City	State Zip Code
Day Phone
Evening Phone
Your Birthday
E-mail
Please check any areas you are interested in:	Direct Support To Residents Visiting residents who have no family near Taking residents on wheelchair rides Taking residents for walks Reading or writing letters for residents Taking residents shopping Grooming activities - assist with beautician, nails, etc. Assist residents to hospital appointments Assist residents to doctor or dental appointments Assist in craft room / activities Playing games (Bingo, Checkers, Dominoes, Chess, etc.) Leading Bible trivia questions game Reading newspaper or discussing current events Kitchen fun (giving demonstrations on baking, etc.) Help with picnics and special outings Help with coffee hours Help in Alzheimer's Unit Help take orders and serve meals to residents in the dining rooms Indirect or Minimal Support to Residents Help with monthly birthday party Help in General Store Help serve and prepare for Family Night Provide entertainment for Family Night Provide musical entertainment (piano, organ, accordian, etc.) Driving Home van to take residents to appointments and/or trips Cleaning out residents' drawers and closets Assist with folding clothes - laundry Indirect Volunteer Work Typing, answering phone, office work Cleaning supply cupboards Sewing projects Assist with lawn care Caring for flower beds Maintenance assistance (painting, etc.) Your Home Having a group to your home for lunch/coffee Bake for coffee hours Mending for residents Typing
How often would you like to volunteer?	Twice Weekly Weekly Every two weeks Longer interval? Please specify:
What day(s) of the week do you prefer?	Monday Tuesday Wednesday Thursday Friday
What time of day do you prefer?	Mornings Afternoons Evenings
Period of time you are able to serve?	2 hours 3 hours 4 hours Longer?
Please add any questions or comments or list other areas you would be interested in volunteering for:
Preferred method for us to contact you (select one)	by Phone via E-mail Either is fine
IMPORTANT NOTICE ABOUT YOUR PRIVACY: We value your privacy. We will not sell or give away any personal information you submit here.
	To submit this form, please enter the code as shown in the box to the left below: