Volunteer Sign-up Form for Coffee Club ☕️🤝
Please fill out your details to join and support the Coffee Club activities.
Full Name
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First Name
Last Name
Email Address
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example@example.com
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
EMERGENCY CONTACT NUMBER:
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Please enter a valid phone number.
Format: (000) 000-0000.
Preferred Volunteer Days (9:45 am - 2:15 pm)
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Tuesday
Wednesday
Thursday
Areas of Interest / Skills
Serving Beverages and Snacks
Event Setup and Close
Cleaning
Baking
Administrative Support
What experience have you had working with the senior population; especially those with cognitive decline or dementia?
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What are your special interests or hobbies that might be useful in working with the clients of this program?
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What strengths do you possess that will make this a good experience for the participants, families, and you?
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What do you expect will be the most rewarding aspect of your volunteer work in the program?
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What do you think will be the most challenging part?
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Will you be able to attend volunteer training sessions to learn more about supporting the elderly, the disease process and communication and care techniques?
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Please Select
Yes
No
Depends on date, but I would be interested
When are you available for an interview, tour and introduction to the program?
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Social Media and Marketing Opt-in
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Please Select
I give my permission for Caregiver Bridge to use my first name, photos or videos to promote the program.
I do NOT give my permission for Caregiver Bridge to use my first name, photos or videos to promote the program.
VOLUNTEER CODE of CONDUCT:
- I understand that I will be exposed to information of a confidential nature pertaining to the participant/family in the course of my work with Memory Care Respite of Florence. I further understand that this information is to be kept confidential and that I will discuss it only with the staff and volunteers who are directly involved in the care of the participant/ family. Confidentiality includes but is not limited to information about client's names, diagnosis, or special family circumstances. - I understand that I am working with a vulnerable population and it is my duty to report incidents of questionable care/abuse/neglect to Adult Protective Services. I will not accept monetary gifts from participants or offer them financial assistance. - I hereby agree that I will not falsify, alter, copy, remove, destroy, or disclose any information or records regarding the Memory Care Respite Center's program without proper written authorization. I further agree not to use any organizational or client records for personal use or gains. - I understand that volunteering requires adherence to COVID protocols. If I or a close family member is exposed to COVID 19 I will immediately notify the executive director so precautions can be taken.
Signature
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