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Volunteer Questionnaire Form
For people who wish to volunteer for Sanctuary UCC's Medford Cares program.
Tell us about yourself:
What is your birthdate?
Tell us how much time you have available for volunteer activities (hours per week/ month).
Do you think that isolation is a problem in the Medford Community?
Yes, Very much so
Yes, A good amount
I don't notice it
Maybe a little bit
Not at all
Would you be willing to spend time with someone who feels isolated in the Medford Community?
Not at all
To help us make a better match for your volunteer interest, please select all of the activities which you have an interest in?
Playing board games, cards
Art (drawing, painting, pottery)
Sewing, knitting, crocheting
Film, Theater, Concerts, Movies
Walking, Nature, Gardening
Crossword, Puzzles, Sudoku
Storytelling, talking with friends
How do you identify spiritually/religiously?
Do you have a vehicle that you would be willing to use if necessary?
Which of these roles appeal to you? (Select all that apply)
Visitor (Visit people who have difficulty leaving their homes)
Gatherer (Locate and deliver goods to people who are housebound)
Organizer (Plan the logistical aspect of the program)
Restorer (Able to fix things like household appliances, etc)
Maker (Create tangible items with skills such as baking, sewing, knitting, etc)
Preparer (Teach skills that would aid in a person's development)
Do you enjoy organizing people/ things?
Only if I have to
How did you hear about this program?
Word of mouth
Sanctuary UCC member
When is best for you to do a quick training session?
In the evening, during the week.
In the morning on the weekend
What is the best way for us to contact you?
For Volunteers under age 21:
Please provide the following contact information regarding your parent/ guardian
Parent/ Guardian Name:
Parent/ Guardian Phone:
Parent/ Guardian Email:
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