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Volunteer Group Registration
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* Indicates required question
Name of Organization
*
How did you hear about Caregiver Companion
Your answer
Name
*
Your answer
Phone: Home or Cell
*
Your answer
Do you prefer texting?
*
Please check the appropriate box.
Yes
No
Required
E-mail Address
*
Your answer
Birthdate
*
Your answer
Area of Study: Major or Minor
*
Hobbies and Interests
Your answer
Do you object to a smoking environment?
*
Yes
No
Required
Do you object to an environment with pets?
*
Yes
No
Required
Volunteer Assignment Choices
*
Check which areas interest you and you are willing to accept.
Visiting
Grocery Shopping/Errands
Yard Work/Mowing
Light Housework
Home Repairs
Respite Breaks
Required
What is your method of transportation?
*
Your Own Car
City Bus
Required
References: Please list 1 reference who is NOT a family member.
*
We need Name, Phone or E-mail of the reference.
Your answer
Photo Release
*
Permission to use your photograph in publications for Caregiver Companion.
Yes
No
Required
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