Volunteer Packet

Volunteer Packet
Dear Prospective Volunteer,

Thank you for your interest in volunteering at Woodbury Heights Nursing and Rehabilitation Center! We welcome the opportunity to work with you and will do everything possible to make your time with us a very meaningful experience.

This form has everything you need to get started:
- Volunteer Application
- Health Assessment Questionnaire
- Tuberculosis Screening Form
- Consent Form (for applicants under 18 years of age)
Please complete the application here and it will be automatically sent to the Therapeutic Recreation & Volunteer Department. This ensures that we have all the documentation required by the New York State Department of Health for you to volunteer.

All volunteers must be at least 14 years of age. An orientation will be scheduled after medical clearance is received. You will need documentation of:
- Immunizations approved by a medical doctor,
- PPD test - which you may receive from your private doctor or at Cold Spring Hills, free of charge; skin tests will be placed and read in the Medical Office (clinic hours listed on Health Assessment attachment),
- Proof of Flu Vaccine (or signed Flu Vaccine Declination attachment),
- Proof of COVID-19 Vaccine
We really appreciate your willingness to volunteer with us. We look forward to hearing from you and welcoming you to our program. If you have any questions or need additional information, please feel free to contact me at (516) 622-7841.

Best Wishes!

Adele Sadocha

Director of Therapeutic Recreation

Volunteer Coordinator

Application
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Please Verify Your Email Address*

In accordance with state law, all employees and volunteers are required to provide their Social Security Number & Date of Birth to receive sexual offense clearance.
Your Date of Birth*

MonthDayYear
Date
Age
Social Security Number*
Today's Date

MonthDayYear
Date

Consent
My child, {name}, has chosen to become a volunteer at Cold Spring Hills. They are 14 years old or older and has completed a medical assessment. Please review and co-sign the assessment.

In accordance with Cold Spring Hills Policy, all volunteers must provide proof of immunization for Measles (Rubeola), Mumps (Parotitis), German Measles (Rubella), a PPD test, and a PPD Booster. If they have a history of a positive PPD, then a chest x-ray report will be required from within the past year. If {name} has not had a PPD test and a booster, your doctor can give them one or our medical office can provide one free of charge.

A PPD or Tuberculin skin test is a test given to see if there has been an exposure to (TB) Tuberculosis.

I understand that because {name} is under 18, I must sign this consent form giving my permission for Cold Spring Hills to administer the PPD test and the PPD booster if required.

Further, by signing below, I am consenting to {name} volunteering at Cold Spring Hills. I have listed myself as an emergency contact and will be responsive to the facility regarding {name} volunteering.
Your Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Date*

MonthDayYear
Date
Signature*

Clear

General Information

This information is optional, but it helps us place you in the most appropriate area
Educational Background
Community Affiliations
Talents / Skills / Interests
Days Available

SundayMondayTuesdayWednesdayThursdayFridaySaturday
Any specific days / times you are available to volunteer?
Were you referred by anyone?*

YesNo
By Whom?*

Emergency Contact
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.
Primary Doctor
Doctor's Phone Number
Please enter a valid phone number.
Do you have any physical limitations*

YesNo
What limitations?*
We will endeavor to accommodate to your needs

References

Please provide 3 references. They can be professional, school, community-based, etc.
Reference*
Phone Number*
Please enter a valid phone number.
Reference*
Phone Number*
Please enter a valid phone number.
Reference*
Phone Number*
Please enter a valid phone number.
Should be Empty:

Volunteer Packet

Application

In accordance with state law, all employees and volunteers are required to provide their Social Security Number & Date of Birth to receive sexual offense clearance.

Consent

General Information

Emergency Contact

References