Adopt-A-Safta Volunteer Registration Form
Please fill this Adopt-A-Safta volunteer registration form out in full. The details provided are kept fully confidential. We will be using this information for internal organizational usage only for the purpose of pairing volunteers with Holocaust Survivors. For any questions, please email 
Sign in to Google to save your progress. Learn more
Last Name *
First Name *
Cell Number *
Email *
City *
1st Language Spoken Conversationally *
2nd Language Spoken Conversationally
3rd Language Spoken Conversationally
What is your religion? *
Country of birth *
Age *
Profession *
Your Talents & Hobbies *
Example: Play piano, like to draw, write poetry, singing opera, can give lectures on history, yoga etc...
Teudat Zeut or Passport Number *
Male or Female *
Do you have a car to use for volunteer purposes? *
I can commit to meeting with my adopted grandparent once a week for a minimum of one year. *
Would you prefer a grandmother or grandfather? *
Do you have a personal connection to the Holocaust, and do you have any additional comments for the Adopt-A-Safta coordinators?
Are you interested in taking on a leadership role within our organization? *
Whatsapp cell # if different from phone above.
Confidentiality Agreement *
If approved, I agree to keep the details of my adopted grandparent’s confidential including full name, ID number, address, country of origin, places where they were and people they were with during World War II, relevant medical information, etc...and other confidential information. Therefore, you hereby undertake and maintain confidentiality of all material that will be disclosed to you and accordingly declare that you will only use it for the sole for purpose of volunteering. Note that by checking the "I agree" box, you are consenting to this confidentiality clause being binding upon you.
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy