Decrease Font Size     Increase Font Size

Volunteer Application

Date:

Name:

Address:

City:

State:

Zip Code:

Phone Number:

Email:

Volunteer opportunity you are interested in (check all that apply):
Directly with residents/clientsAgency Sponsored Events/ActivitiesChildcare Center

References: Please list two (2) persons not related to you whom we may contact
Phone:
Phone:

Are you volunteering to meet class requirement?
YesNo

If yes, the number of hours required:

Please list specific days and times you are interested in volunteering directly with the residents or clients:

Or, please list specific events you may be interested in volunteering for:

What are you hoping to achieve by volunteering for Hills & Dales?

Have you ever been convicted of a crime?:
YesNo

If Yes, please explain

Recreation Activities

Please check those of interest

Art
DrawingPaintingColoringPlay InstrumentsVoice Lessons/Singing

Community
Sport EventsShoppingOut to EatRec. CenterMovie TheatersConcertsLibraryZooField TripsClubs/BarsMusicalsMuseumsCoffee HousesChurchSpecial Olympics

Crafts
Crochet/KnitClay/CeramicsNeedle PointLatch HookWoodworkingSewingCross StitchPlastic CraftsEmbroidery

Games
Card GamesPuzzlesLawn GamesVideo GamesWord SearchBoard GamesCrossword Puzzles

Hobbies
ModelsCollectionsPhotographyOther

Miscellaneous
CookingTVMagazinesTapes/CDsRenting VideosWritingReadingOther

Physical
Team SportsIndividual SportsSwimmingPing Pong/PoolBicyclingBowlingSkiingDancingFootballAerobicsTae Kwon Do/KarateGymnasticsSoftballBasketballGolfWeightlifting

Outdoor
PicnicsWalking/HikingCar RidesRollerskatingNature ActivitiesGardeningFishingBoatingCampingIce SkatingRoller-bladingHuntingGo to a parkSledding