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MIDDLETON SENIOR CENTER VOLUNTEER APPLICATION Welcome to the Middleton Senior Center! We are pleased you are interested in volunteering. Our volunteers provide an invaluable service to the seniors living in Middleton; thank you for applying for a volunteer position! Name: Date: Address: Cell phone: Birth date: E-mail: Previous Work Experiences: Previous Volunteer Experience: Education: Clubs or Organizational Affiliations: Why do you want to volunteer? How did you hear about this volunteer opportunity? Volunteer Opportunities □ Receptionist □ Tax Counseling □ Greeter, host/hostess □ Tax Intake □ Dining Center □ Group Leader □ Meals on Wheels Driver □ Decorating □ Meals on 2 Wheels (bike) □ Men’s Group Driver □ RSVP Driver Escort □ Health Fair □ Friendly Visitor/Friendly Listener □ Data Entry □ Knitting/Sewing Projects □ Flower Care □ Blood Pressure Nurse/ Assistant □ Musician □ Foot Care Clinic Assistant □ Special Projects □ Newsletter Collating □ Bill Paying/Checkbook Balancing □ Yard Work/Snow Shoveling □ Mending □ Marketing/Center Ambassador □ Loan Closet □ Bakery Assistant □ Pick Up & Delivery □ Activity/Travel Planning □ Intergenerational Training/ Skills □ Arts/Crafts/Quilting □ Computer Experience □ Food Service/Meal Prep. □ Health Services: RN, PT, OT, Aide □ Performer □ Photography/Photoshop/Scrapbook □ Public Relations □ Reception/Visitor Experience □ Other □ Other Talents/ Interests Hobbies Limitations □ Heavy Lifting □ Limited Walking □ Low Vision □ Limited Hearing □ Other Restrictions Submit ---PAGE BREAK--- Availability □ Weekdays □ Weekends □Flexible □ AM □ PM Expected Level of Service: □ Weekly □ References—Please list two references not related to you whom we may contact. 1. Name: Address: Address: Telephone: Telephone: In Case Of Emergency Notify Name: Name: Address: Address: Telephone: Telephone: Relationship: Relationship: Volunteer Release Form Confidentiality: All volunteers of the Middleton Senior Center shall maintain confidentiality in the handling and use of participant information and records. Any information relating to individuals attending programs or activities at the Middleton Senior Center is not to be discussed at anytime within or outside the Middleton Senior Center. This information may include personal information about staff, participants or overall agency business. Signature: THANK YOU FOR VOLUNTEERING! SIGN