Legal Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Best Time to Call
*
E-mail
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What is the purpose of your volunteering interest?
Have you volunteered in the past? Please give details of when (dates) and where.
Have you ever been arrested and/or convicted of a felony? If yes Please Explain
I acknowledge that Lighthouse Assisted Living will do a background check on all volunteers older than 16. (please enter your initials)
*
If under 10 years old please tell us who will be coming with you to volunteer
I ACKNOWLEDGE THAT ALL PICTURES AND PHOTOS THAT MAY BE TAKEN DURING THE TIME OF VOLUNTEERING ARE THE PROPERTY OF LIGHTHOUSE ASSISTED LIVING AND MAY BE USED FOR MARKETING AND WITH RESIDENT COMMUNICATION (please enter your initials)
*
I ACKNOWLEDGE THAT ANY INFORMATION REGARDING RESIDENTS, FAMILY MEMBERS OR STAFF IS CONFIDENTIAL. THIS INCLUDES BUT IS NOT LIMITED TO MEDICAL, PHYSICAL OR OTHER INFORMATION. THIS MAY NOT BE DISCUSSED WITH ANYONE OUTSIDE LIGHTHOUSE ASSISTED LIVING. PHOTOS MAY ONLY BE TAKEN WITH PERMISSION. RESIDENTS MAY NOT BE TAKEN OFF PREMISES BY VOLUNTEER UNLESS THE POA HAS GIVEN WRITTEN PERMISSION TO LIGHTHOUSE ASSISTED LIVING (please enter your initials)
*
BY SIGNING THIS APPLICATION, I ACKNOWLEDGE, TO THE BEST OF MY ABILITY, THAT ALL OF THE INFORMATION GIVEN IS TRUE. (Please enter your first and last name)
Send
Should be Empty: