Volunteer Application for the White Bear Area Senior Program
2484 East County Road F
White Bear Lake, MN 55110
651-653-3121
www.whitebearseniorprogram.org
First Name *
Last Name *
Best phone number to reach you *
Email Address *
Home/Street Address *
City *
Zip Code *
Do you have any limitations that would affect your volunteer placement? (For example, unable to lift more that 7lbs.) Please explain.
Areas of Volunteer Service
Please indicate the areas you are interested in.
White Bear Area Senior Center
White Bear Area Meals on Wheels
Community Partner
White Bear Lake Area Schools
What mornings are you available to volunteer?
What afternoons are you available?
Time available to volunteer
Clear selection
Emergency Contact - Name and phone number
Matching Gift Program: Does your company participate in a Matching Gift Program for volunteer work?
The above information is correct to the best of my knowledge. I understand that this form is confidential and its contents will not be released to anyone without my written consent. I agree to notify the White Bear Area Senior Program of any changes in the above information.
Some volunteer positions require a background check. Do you give permission for us to initiate a background check (if required)?
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