Visit Report for Active Volunteers
Thank you for volunteering with the It Takes a Village! Please submit this very quick form after each in-home visit. If you are concerned about your family or need support please call or text Lisa at (413) 455-5008 or Lisa@HilltownVillage.org
Volunteer's Name *
Your answer
Family's Name *
Your answer
Date of Visit *
MM
/
DD
/
YYYY
Including this visit, what are the total number of visits you have made to this family? *
Your answer
What types of support did you provide for your Village family during this visit? *
Check all that apply
Required
What were the highlights of your visit? *
Please elaborate on one or two things you did during your visit. What specific skill, if any, did you teach? What specific resource did you refer to?
Your answer
What challenges, if any, came up? Do you or your family have any concerns or need assistance? *
Your answer
What is the date for your next visit? *
MM
/
DD
/
YYYY
Time
:
If you would like to be reimbursed for miles driven ($0.14 per mile), enter total miles to/from the family's home
Your answer
Thank you for your service!
Please remember to schedule the next visit with your family before you leave or soon after -- it helps the family feel supported.
Also, please remember that volunteers must never be left alone in the family's home while they are away, or alone with any children while a parent is not readily available.
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