VISTE Volunteer Interest Form
Volunteers in Service to the Elderly
First Name
Your answer
Last Name
Your answer
Street
Your answer
City
Your answer
State
Your answer
Zip Code
Your answer
Phone Number
Your answer
Cell Phone
Your answer
Email
Your answer
Date of Birth
MM
/
DD
/
YYYY
Emergency Contact Name
Your answer
Emergency Contact Phone Number
Your answer
Employer and position (or school and grade)
Your answer
Relevant work or volunteer experience, special interests, clubs/organizations, etc.
Your answer
Are you a VISTE client?
List any foreign languages you speak
Your answer
Will you use your personal vehicle for volunteering? (delivering food, etc)
If you plan to use your own vehicle, please list your Driver's License number and date of expiration.
Your answer
How Would You Like to Help?
There are so many ways you can be a volunteer in service to the elderly!
1. Drive clients to appointments (requires your own transportation)
2. Phone Pals (call clients once a week to check on them and have friendly conversation)
3. Deliver Hot Meals (requires your own transportation)
Required
4. Deliver a Box of Groceries (one morning a month, requires your own transportation)
5. Make baked goods at home
6. Deliver birthday cakes once a month (Fridays, 12-3pm; requires your own transportation)
7. Yard work for clients (as needed)
8. Minor home repairs for clients (as needed)
9. Which days of the week do you prefer to help?
Required
10. In which zip codes do you prefer to help?
Your answer
11. Are there any other ways you'd like to help?
Your answer
12. Is there anything else you'd like to share?
Your answer
Volunteer Agreement
Please read the following and indicate your agreement below.

1. I will be punctual and conscientious, conduct myself with dignity, courtesy and consideration of others, and endeavor to make my work professional in quality.
2. I will at all times while engaged in volunteer activities uphold the philosophy and ethical principles of VISTE.
3. I will sign in and out of the volunteer log each day.
4. I will enter and exit through the front door only and understand that there are no exceptions to this rule, regardless of where I park.
5. I will obtain and prominently wear my name badge for the duration of my work in the warehouse, returning it to the basket by the volunteer log before signing out.
6. I will wear close-toed shoes and maintain a neat and clean appearance at all times while on duty in the warehouse.
7. I will not remove products from the warehouse.
8. I will not wear headphones while on duty.
9. I will make my best effort to fulfill my commitment to VISTE by completing all assignments that I accept.
10. I will immediately report any accidents/injury to my supervisor.
11. I understand that the Volunteer Services Department reserves the right to terminate my volunteer status as a result of:
a. Failure to comply with policies, rules and regulations
b. Unsatisfactory attitude, work, or appearance
c. Any other circumstances which, in the judgment of the Program Director, would make my continued services as a volunteer contrary to the best interest of the organization.
I have read each of the above conditions and I agree to adhere to them.

I agree to statements above.
Personal Reference Name
Your answer
Personal Reference Phone
Your answer
Personal Reference Relationship
Your answer
How did you learn about VISTE?
Your answer
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