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
* Required
First Name
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Your answer
Last Name
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Your answer
Best phone number to reach you
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Your answer
Email Address
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Your answer
Home/Street Address
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Your answer
City
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Your answer
Zip Code
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Your answer
Do you have any limitations that would affect your volunteer placement? (For example, unable to lift more that 7lbs.) Please explain.
Your answer
Areas of Volunteer Service
Please indicate the areas you are interested in.
White Bear Area Senior Center
Clean Crew
Foot Care Clinic
Office Assistant
Advisory Team
Other:
White Bear Area Meals on Wheels
Route Driver
Kitchen Aid
Other:
Community Partner
Senior Companion
Senior Driver
Senior Chore
Other:
White Bear Lake Area Schools
Elementary School Volunteer
Special Events
Other:
What mornings are you available to volunteer?
Monday
Tuesday
Wednesday
Thursday
Friday
What afternoons are you available?
Monday
Tuesday
Wednesday
Thursday
Friday
Time available to volunteer
Ongoing
Short Term
Substitute
Special or One Time Projects
Clear selection
Emergency Contact - Name and phone number
Your answer
Matching Gift Program: Does your company participate in a Matching Gift Program for volunteer work?
Yes
No
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.
Please check box
Some volunteer positions require a background check. Do you give permission for us to initiate a background check (if required)?
Yes
No
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