• In Service of Seniors - Pittsburgh and Open Your Heart to a Senior

    New Volunteer Registration

  • Thank you for your interest in volunteering with the In Service of Seniors or Open Your Heart to a Senior program, and helping older adults in our community remain independent in their homes.

    Please complete the following form and we will contact you to arrange an in-person or virtual training (approx. 1 1/2 hours) before we match you up with a senior.

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  • Date of Birth
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  • Race

  • Gender*

  • We want to make sure we address you correctly. Please indicate which pronouns you'd like us to use for you.

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  • Are you a veteran?
  • How did you hear about In Service of Seniors or Open Your Heart to a Senior Program?

  • Please list TWO non-family members (friend, teacher, employer, clergy, etc) who have known you for at least one year who we may contact as character references.

  • How will you most likely travel to your senior(s)?

  • Fill out the following fields ONLY IF you will be driving senior care receivers in your car.

  • Our team works hard to help you get matched with opprotunities that will be a good fit for you.  The following questions are to better assist us with the matching proess.

  • What volunteer opportunities interest you? (check all that apply -- this is not a final commitment!)
  • Are you willing to help someone who smokes?
  • Are you willing to help someone who has pets?
  • Please check the boxes to indicate that you understand your responsibilities as an In Service of Seniors or Open Your Heart to a Senior volunteer.*

  • Pledge of Confidentiality

     I am volunteering my time to help carry out the work of the In Service of Seniors/Open Your Heart to a Senior programs.  I understand that in the course of my volunteer work and experience I may learn certain facts, including protected health information, about individuals I help that are of a highly personal and confidential nature.  Examples of such information include medical conditions and treatment, finances, living arrangements, employment, relations with family members, etc.  I understand that all such information must be treated as completely confidential.  I agree not to disclose any information of a personal and confidential nature to any person other than In Service of Seniors staff members.

     Having read this pledge, I understand and agree to abide by the In Service of Seniors/Open Your Heart to a Senior policy on confidentiality.

     I understand that failure to comply may result in my immediate dismissal as an In Service of Seniors/Open Your Heart to a Senior volunteer.

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