VOLUNTEER FORM

VOLUNTEER INFORMATION & APPLICATION

772.563.0505 | MEMORYANDMOVEMENT.ORG
MISSION STATEMENT

We improve the quality of life for individuals and families in Indian River County who are affected by memory and movement disorders, through support, education, and connection.

VOLUNTEER OPPORTUNITIES

The CENTER FOR MEMORY & MOVEMENT is dedicated to serving community residents affected by disorders impacting memory and movement. Volunteers play an essential role in supporting our mission by providing information, education, support, and advocacy to individuals and families caring for or living with these conditions. Volunteers assist with programs, events, community outreach, and administrative support. We strive to create meaningful opportunities that align with each volunteer’s interests, skills, and availability while helping us better serve our community.

QUALIFICATIONS

Prospective volunteers will meet with CENTER FOR MEMORY & MOVEMENT staff members and receive training prior to beginning their service. Volunteers should have a genuine interest in helping others and providing support to individuals and families who contact the Center or visit the office seeking assistance. Volunteers must be reliable, compassionate, and dedicated to the mission of the organization.

After meeting with a staff member, volunteers will complete a VOLUNTEER APPLICATION. All volunteers are required to sign a Confidentiality Agreement, work collaboratively as part of a team, demonstrate dependability, support the mission of the organization, and help promote a positive and welcoming environment. Volunteers are also asked to complete a VOLUNTEER HOURS SHEET after each day of service in the office or while assisting in the community.
WAYS TO VOLUNTEER

OFFICE SUPPORT Answering phones, assembling mailings, filing, scanning, and organizing materials.

SOCIAL RESPITE GROUPS Assisting with seniors in programs, distributing snacks, preparing and cleaning activity spaces.

MEMORY SCREENINGS Assisting with paperwork, preparation, filing, and follow-up materials.

DEMENTIA EXPERIENCE Assisting with participant registration, materials, and event support.

COMMUNITY OUTREACH Helping with health fairs and community education events.

FUNDRAISING EVENTS Soliciting sponsorships and auction items, serving on committees, and assisting with setup, guest support, registration, and logistics.

PUBLICITY Distribution of brochures, flyers, and newsletters in the community.

ACTIVITY KITS Assembling and delivering kits for clients and caregivers.

PROJECT LIFESAVER Assisting staff with device battery checks and equipment preparation

VOLUNTEER QUALIFICATIONS

• Interest in supporting individuals and families affected by memory and movement disorders.
• Dependability and commitment to the organization’s mission and values.
• Ability to maintain strict confidentiality.
• Willingness to participate in orientation and training.

The CENTER FOR MEMORY & MOVEMENT staff will work with Volunteers to match them with activities and interests they are comfortable with and that best fits in their schedule.

OFFICE HOURS MONDAY - FRIDAY | 9:00AM - 5:00PM

2300 5TH AVE. #101, VERO BEACH, FL 32960
- VOLUNTEER INFORMATION
- NAME*
- PHONE #*
  Format: (000) 000-0000.
- EMAIL*
- ADDRESS*
- DATE OF BIRTH
  
  MonthDayYear
  *OPTIONAL
- VOLUNTEER EMERGENCY CONTACT
- NAME*
- RELATIONSHIP*
- PHONE #*
  Format: (000) 000-0000.
- VOLUNTEER INTEREST
  
  CHECK ALL THAT APPLY
- OFFICE SUPPORTSOCIAL RESPITE GROUPSMEMORY SCREEINGSDEMENTIA EXPERIENCECOMMUNITY OUTREACH
- FUNDRAISING EVENTSPUBLICITYACTIVITY KITSPROJECT LIFESAVERHEALTH FAIRS
- VOLUNTEER AVAILABILITY
  
  CHECK ALL THAT APPLY
- MONDAYTUESDAYWEDNESDAYTHURSDAYFRIDAYSATURDAY
- MORNINGAFTERNOONEVENING
- SKILLS & EXPERIENCE
- WHY ARE YOU INTERESTED IN VOLUNTEERING WITH THE CENTER FOR MEMORY & MOVEMENT?
- VOLUNTEER CONFIDENTIALITY AGREEMENT
  
  SIGNATURE REQUIRED
- VOLUNTEER CONFIDENTIALITY AGREEMENT
  
  Volunteers must maintain strict confidentiality regarding all information related to the CENTER FOR MEMORY & MOVEMENT, its clients, staff, volunteers, and operations. Information obtained through volunteer service may not be shared with outside individuals without prior written permission.
  
  Failure to follow confidentiality policies may result in termination of volunteer service.
- VOLUNTEER NAME*
- DATE*
  
  MonthDayYear
- VOLUNTEER SIGNATURE*
  
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- COORDINATOR SIGNATURE
  
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- VOLUNTEER PHOTO AND MEDIA RELEASE
  
  SIGNATURE REQUIRED
- VOLUNTEER PHOTO & MEDIA RELEASE
  
  I grant permission to the CENTER FOR MEMORY & MOVEMENT to use photographs or video recordings of me for educational, promotional, and public awareness purposes in print or digital formats.
  
  I understand that these materials may be used in newsletters, brochures, websites, and social media without compensation.
- VOLUNTEER NAME*
- DATE*
  
  MonthDayYear
- VOLUNTEER SIGNATURE*
  
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- MINOR VOLUNTEER PARENTAL CONSENT FORM
  
  Volunteers under 18 who are not accompanied by a parent or legal guardian are required to bring a signed consent form prior to or on the day of the volunteer project otherwise, the minor will not be allowed to volunteer. A parent or legal guardian of each minor must read and agree to the following:
  
  By signing this form I, the parent or legal guardian of the named below, consent to the child’s participation in the volunteer activities organized by Alzheimer and Parkinson Association of IRC. I understand that the child will be provided with orientation and training necessary for performance of the volunteer duties. I understand that my child will receive no monetary compensation for this work.
  
  By signing this form I also understand that the volunteer and their parent assume all risks associated with the volunteer work and agree to release, hold harmless and indemnify Alzheimer and Parkinson Association of IRC and associated parties from any and all liability, claims, demands or actions that the participant or any other party may have for personal injury or property damage.
  
  In general, Alzheimer & Parkinson Association of IRC requires that strict confidentiality be maintained with respect to all information obtained by volunteers concerning the organization, as well as the clients and others they serve.
  
  The volunteer shall not disclose any information obtained in the course of his/her volunteer placement to any third parties without prior written consent from the organization. This includes but is not limited to information pertain to financial status and operations such as budget information, donations of money or gifts in kind, salary information, and information pertaining to clients, staff or other volunteers.
  
  No information concerning any volunteer will be divulged without prior written consent of the volunteer. This includes addresses, telephone numbers, etc.
  
  Failure to comply with the confidentially policies of the organization may result in dismissal of the volunteer.
  
  I understand the above and agree to uphold the confidentiality of these matters both during and following my volunteer service with the organization.
- I give permission for my son/daughter, to volunteer at the CENTER FOR MEMORY & MOVEMENT.
- PARENT/GUARDIAN NAME
- PARENT/GUARDIAN PHONE #
  Format: (000) 000-0000.
- PARENT/GUARDIAN EMAIL
- MINOR VOLUNTEER EMERGENCY CONTACT
- EMERGENCY CONTACT PHONE #
- PARENT/GUARDIAN SIGNATURE
  
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- PARENT/GUARDIAN SIGNATURE
  
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- MINOR VOLUNTEER PHOTO & MEDIA RELEASE
  
  To recognize the great work of our volunteers, we occasionally post photographs on our social media platforms (Facebook, Instagram, etc.), on our website or in print materials. Please let us know your preference by checking the appropriate line on the options below.
- I give permission for my child’s name, photo, video image,and/or achievement(s) to be disclosed on social media, on the website, in printmaterials or released to the media.I DO NOT want my child’s name, photo, video image, and/orachievement(s) disclosed on social media, on the website, in print materials orreleased to the media.
- PARENT/GUARDIAN SIGNATURE
  
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- MINOR VOLUNTEER SIGNATURE
  
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- STATEMENT OF INCLUSION
  
  The CENTER FOR MEMORY & MOVEMENT is committed to fostering a welcoming environment that values diversity, equity, and inclusion. We denounce racism, bigotry, and intolerance and strive to ensure that our programs, services, and volunteer opportunities are inclusive and respectful to all members of our community.
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VOLUNTEER INFORMATION & APPLICATION

VOLUNTEER INFORMATION

VOLUNTEER EMERGENCY CONTACT

VOLUNTEER INTEREST

VOLUNTEER AVAILABILITY

VOLUNTEER CONFIDENTIALITY AGREEMENT

VOLUNTEER PHOTO AND MEDIA RELEASE