Volunteer Registration Form

Volunteer Registration Form

Let us know your area of interest to offer volunteer. We will get back soon with updates upon receiving this form.
Full Name*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
Phone Number*

Area CodePhone Number

Preferences in Area of Volunteering

	Would love to!	Would like to.	Wouldn't mind helping.	Not this area.
Transportation
Minor home repairs changing light bulbs or air filters, replacing shower heads
Meal Delivery
Friendly visits
Shopping and Errands
Laundry
simple home cleaning
sit during Chemotherapy
Personal Care during out patient procedures ( transportation to and still till over for return)

Times Available

Do you have a current Phoenix Fingerprint Card?

yesNoN/A if you are not in Phoenix
Are you CPR certified

YesNo
Village 360 requires volunteers to submit to a background check. Criminal conviction does not necessarily bar an applicant from volunteering. The nature of the offense will be taken into consideration before a decision is made. There is no fee on the part of the volunteer for the background check. Screening must be completed before volunteers begin working with clients. Do you agree to submit to a background check?

yesno
Why do you want to volunteer with Village 360
Should be Empty: