VISTE Volunteer Interest Form
Volunteers in Service to the Elderly
First Name *
Your answer
Last Name *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Home Phone
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?
Drive clients to appointments *
Requires own transportation. Monday-Friday only.
Phone Pals *
Weekly reassurance calls to a set list of clients; check on them and have friendly conversation.
Deliver Hot Meals *
Requires your own transportation. Tuesdays & Thursdays only.
Required
Deliver Supplemental Grocery Boxes *
One morning a month. Requires your own transportation.
Deliver Birthday Cakes *
2nd Friday of the month. Pick-up between 12-3:30pm. Requires your own transportation.
Help in our Office *
Making calls, filing, etc.
Help in our Warehouse *
Includes sorting food donations, packing commodity boxes, other tasks as needed. Mornings, 8am-12pm.
Make baked goods at home *
Baking cake layers for our birthday cakes or treats for hot meals.
Yard work for clients *
Minor home repairs for clients *
Which days of the week do you prefer to help? *
Required
In which zip codes do you prefer to help?
Are there any other ways you'd like to help?
Your answer
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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