Volunteer Form

Where are you looking to Volunteer?(Required)

Ingleside at Rock Creek

Westminster at Lake Ridge

Ingleside at King Farm

Contact

Name(Required)

First Last

Email(Required)

Cell Phone

Home Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Emergency Contact

Name

First and Last Name

Phone

I am

an adult

a student

I am

13-18 years old.

over age 18.

About

What school do you attend?

Are you a relative of anyone employed at Ingleside?

Yes

If so, what is their name and job?

Why would you like to volunteer at Ingleside?

How did you hear about volunteer opportunities at Ingleside?

Friend or Relative

Volunteer Match

Ingleside website

School counselor

SSL website

Date you are available to begin volunteering.

End date, if any

What days are you available to volunteer?

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Do you prefer to volunteer in the

Mornings

Afternoons

All Day

Are you looking for a short-term or long-term volunteer opportunity?

Short-term

Long-term

Please indicate the types of volunteer opportunities that interest you most, below.

Please note that many opportunities are only available at certain times or on certain days, so your volunteer assignment is partially dependent on what days and hours you are available to volunteer.

If you have a unique talent or skill that you would like to offer as a volunteer, please indicate what that is:

If you would like to visit with residents who speak a language other than English, please indicate that language here:

Have you ever been convicted of a criminal offense other than minor traffic violations?

Yes

References

Please provide two personal references that we may contact (other than relatives).

Name

First Last

How you know this person

Years Known

Phone

Name

First Last

How you know this person

Years Known

Phone

Emergency Contacts

Please provide two emergency contacts.

Name

First Last

Relationship

Phone

Name

First Last

Relationship

Phone

Agreements and Authorizations

The first 5 agreements are required, the last is optional.

Please click the check box if you agree:

I understand the importance of consistency and agree to be prompt on my scheduled days. If I cannot volunteer on a given day, I will notify the department to which I have been assigned or the Manager of Community Engagement.

I authorize Ingleside to check my references, and to secure a background check if applicable.

I (or my guardian) understand(s) that Ingleside assumes no liability while I volunteer on the premises or take part in volunteer activities.

I agree to abide by the Ingleside requirement for confidentiality. This means that I will share information only with pertinent professional staff members, including the Manager of Community Engagement, Nurse Manager, or Social Worker, where I am assigned.

I hereby affirm that my answers to the foregoing questions on the volunteer application are true and correct, and that I am not knowingly withheld any fact or circumstance which would, if disclosed, affect my application unfavorably.

I give permission to Ingleside to use my picture on slide shows, newspapers, magazines, our website, and other electronic media.

Full Name as it appears on your social security card

Date

Online Safety for Seniors: Cybersecurity Guidance from Ingleside’s IT Security Director

Navigating Dementia: Six Ways to Support Brain Health as You Age

Contact

Emergency Contact

About

References

Emergency Contacts

Agreements and Authorizations

Online Safety for Seniors: Cybersecurity Guidance from Ingleside’s IT Security Director

Navigating Dementia: Six Ways to Support Brain Health as You Age

Volunteer Form

Text

Volunteer Form

Contact

Emergency Contact

About

References

Emergency Contacts

Agreements and Authorizations