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 info@AdoptASafta.com.
Last Name *
Your answer
First Name *
Your answer
Cellphone Number *
Your answer
Email Address *
Your answer
Male or Female *
What city do you live near? *
If the Tel Aviv area, which parts would you visit?
You can choose multiple areas of visitation if relevant for you.
What is your preferred neighboorhood for volunteering?
Please note, there is no guarantee that this request will be honored, but you will be notified in advance to confirm a potential location.
Your answer
Home Address *
Your answer
1st Language Spoken Conversationally *
Your answer
2nd Language Spoken Conversationally
If relevant
Your answer
Other Languages Spoken Conversationally
If relevant
Your answer
What is your religion? *
Your answer
Do you have a car to use for volunteer purposes? *
Yes, 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? *
We typically only set up grandfathers with male volunteers, but both male and female volunteers can adopt a grandmother.
Do you have a personal connection to the Holocaust, and do you have any additional comments for the Adopt-A-Safta coordinators? *
Your answer
Are you interested in taking on a leadership role within our organization? *
This may include coordinating groups of volunteers.
Have you attended one of our Adopt-A-Safta training sessions? *
Country of Birth *
Your answer
Date of Birth *
Your answer
Profession *
Your answer
Teudat Zeut or Passport Number *
Your answer
Your Talents & Hobbies *
Example: Play piano, like to draw, write poetry, enjoy singing opera, can give lectures on history, yoga etc...
Your answer
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.
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy