Volunteer

Volunteer Application

* Indicates required field

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Phone Number *

Times Available:
Most seniors prefer meeting during the day (10 am - 5 pm)

Days / Times (e.g. Mon & Wed 9 - 12) *

How many hours do you want to volunteer per month? *

Do you prefer volunteering with... *

The Como Park/Falcon Heights Living at Home Block Nurse Program agrees:

To provide a Volunteer Coordinator who will arrange all necessary orientation, training and supervision for the volunteer position.
To change the volunteer assignment or add new duties only by mutual agreement between the Volunteer and the Volunteer Coordinator.
To keep an account of volunteer hours, review performance on a regular basis and provide a letter of reference when requested.

The Volunteer agrees:

To maintain confidentiality and respect client privacy at all times.
To dispense no medication or provide "hands on" care.
To accept no gifts worth more than $5.00, nor enter into any arrangement with the client which might be to your financial benefit.
To attend orientation and to become familiar with the Living at Home Block Nurse Program policies and procedures.
To maintain a record of volunteer time and submit monthly.
To notify the Volunteer Coordinator of extended leave or resignation

Signature *

Date *

Submit

Download this application to fill out and mail back to:
Como Park Lutheran Church
Attn: Block Nurse Program
1376 Hoyt Ave. W.
St. Paul, MN 55108

Volunteer Application to download and mail in

Open this volunteer application to fill out electronically and email back to us. Download to your computer, then open it & fill it out, save it and email it back.

Como Park/Falcon Heights

Volunteer

Volunteer Application

Volunteer Application

Volunteer Form

Home

About

Services

Resources

Contact