Applications

Please choose a form:

Adult
Junior

Name

* First Name	* Last Name	M.I.

Birthday

Month	Day	Year

Address

* Street	* City	* State	* Zip

Contact Info

* Home Phone	Work Phone	* E-mail Address

Education & Experience

Highest Grade Completed

Major (if College Graduate)

Current Occupation	Former Occupation (if retired)

Volunteering Experience (please include responsibilities)

Clubs or Church to which you belong

Hobbies, Interests & Skills

Availability

Please provide full availability:

Check if you are available for the following:
Summer Holidays Weekends Help with Special Events

Personal Info

Are there any physical limitations which should be considered in your volunteer assignment?
Yes No Please explain:

Have you ever been convicted of a felony?
Yes No Please explain:

Have you ever been dismissed from volunteer services due to abuse of residents or clients?
Yes No Please explain:

Volunteer Opportunities

Check all interests that apply:
Friendly Visitor	Care Assistant
Activities Aides	Transport residents in wheelchairs
Present a program	Read to residents
Write letters for residents	Feed residents
Assist with exercises for residents	Chapel Aides
Run a video for residents	Gift Shop Salesperson
Assisted Living Aide	Other

References

Referred By

Reference #1:
Reference Name	Reference Address	Reference Phone

Reference #2:
Reference Name	Reference Address	Reference Phone

Emergency Contact

School

Parents/Guardians

Emergency Contact Name

Home Phone	Work Phone

Family Physician	Office Number

By sending this form, you have read the statement of commitment and confidentiality.

In This Section

Upcoming Events

Tuesday, Mar 16th 2010
10:30 am - 11:30 am
Senior Pathways - Gold in Your Attic
Tuesday, Mar 23rd 2010
10:30 am - 11:30 am
Wellness & Vitality - Nutrition from the Ground Up
Friday, Apr 9th 2010
7:30 pm - 8:30 am
Arts & Artists - Classical Goes Jazz

View All Events

Collection and disclosure of information: Moravian Hall Square collects Personal Information from eligible individuals who affirmatively request to receive e-mail from Moravian Hall Square. We call this "Personal Information," and it includes, by way of illustration, names, addresses, telephone numbers and e-mail addresses.

We collect this Personal Information in order to provide individuals with timely information via e-mail regarding events, resources and news. It is our policy not to make Personal Information available to anyone other than our Moravian Hall Square staff.

Subscribers to our e-mail list may terminate their subscriptions via a link at the bottom of each email sent from Moravian.com

Moravian Hall Square

Applications

In This Section

Upcoming Events

Tuesday, Mar 16th 2010

Tuesday, Mar 23rd 2010

Friday, Apr 9th 2010