Volunteer Application
This is the volunteer application for Fairview Haven. Please complete the contact information, experience, availability, volunteer interests, and consent sections below. We appreciate your interest in serving our community!
First Name
*
M.I.
*
Last Name
*
Birthday
*
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Month
-
Day
Year
Date
Street Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
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The Bahamas
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Benin
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Bhutan
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Brazil
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Bulgaria
Burkina Faso
Burundi
Cambodia
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Canada
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Cocos (Keeling) Islands
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Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
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Northern Mariana
Norway
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Papua New Guinea
Paraguay
Peru
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Poland
Portugal
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Republic of the Congo
Romania
Russia
Rwanda
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Samoa
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eSwatini
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Syria
Taiwan
Tajikistan
Tanzania
Thailand
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Tonga
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Other
Country
Home Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Cell Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
example@example.com
What are the most effective ways to contact you?
*
Text
Call
Email
Emergency Contact Information
Emergency Contact
*
First Name
Last Name
Relationship to You
*
Please Select
Parent
Spouse
Sibling
Friend
Child
Other
Emergency Contact Home Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Cell Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Current Volunteer Status
Please specify:
*
I am interested in becoming a volunteer at Fairview Haven.
I currently volunteer at Fairview Haven.
If you are currently volunteering at Fairview Haven, please specify how you are volunteering below:
Experience, Interests, Skills
Volunteer Experience
Hobbies & Interests
Skills & Abilities
Musical, clerical, computer, painting, etc.
Availability
Preferred scheduling option
*
I would like to be contacted as needed.
I would like regularly scheduled volunteer hours/days.
If regularly scheduled, how often?
Monthly
Bi-weekly
Weekly
Daily
Availability by day and time
Rows
Morning
Afternoon
Evening
Specific hours
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Types of Volunteer Work
Please check everything you would be interested in.
Maintenance
Weeding
Planting Flowers
Watering Flowers
Snow Removal
Room Painting
Wheelchair Repairs
Housekeeping
Window Washing
Spring/Fall Cleaning
Carpet Cleaning
Transportation
Bus & Van drivers for appointments and activities
Volunteer Nurse or CNA to accompany residents to appointments
Take residents on Golf Cart Rides
Take residents on Bike Rides (electric bike)
Dining Services
Fill and pass water pitchers to resident rooms
Pass snacks to resident rooms
Pass meal trays in dining room
Provide home baked pies for pie day
Business
Paper Shredding
Evening Receptionist (5:30-7:30pm)
Daytime/Weekend Receptionist Sub
Resident Interviews
Laundry
Fold Towels
Mending
Help with SV Laundry
Entertainment
Play the piano or other instruments
Bring your musical/singing group to share
Resident Visits
Read to residents
Visit/sit with residents
“Adopt” a resident
Bring in children
Bring in a pet
Activities
Bake cakes for birthday parties
Provide baked goods for bake sale
Host a homemade meal for residents
Host Mens’ Coffee Hour at FVH/SV
Host Ladies’ Teatime at FVH/SV
Bring your children for Baby Joy
Attend Monthly Sing-Along
Assist with Bingo
Assist with Saturday Coffee Socials
Other
What would be your top choices of volunteer work?
Events
Events of Interest
Resident/Family Potlucks
Ladies’ Banquet
Bubbles & Cookies
Cissna Park Picnic
Father/Son Cookout
Annual Homemade Ice Cream Day
Independence Day Cookout
Wiener Roast
Annual Benefit/Auction
Resident/Staff Christmas Supper
New Year’s Eve Party
Volunteer Consent
Notes
I understand that if accepted as a volunteer:
I voluntarily offer my services with the understanding there will be no monetary compensation.
I agree to conform to all policies, procedures, and regulations.
I will satisfy any health screening requirements.
If requested, I will submit references and/or submit to a background check.
I certify that the information contained in this questionnaire is correct to the best of my knowledge.
Please sign below:
*
Date
*
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Month
-
Day
Year
Date
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