VOLUNTEER APPLICATION

First Name *

Last Name *

Address 1 *

Address 2

City *

State/Province *

Zip *

Email *

Phone *

Phone Type *

Phone2

Phone Type 2

AHOTS requires our volunteers to be vaccinated against Covid-19.

Covid-19 Vaccination Status *

EMERGENCY CONTACT INFORMATION

Please provide the name and number of someone we can contact in case of emergency.

Emergency Contact First Name *

Emergency Contact Last Name *

Emergency Contact Phone Number *

Emergency Contact Email *

Emergency Contact Relationship *

VOLUNTEER INTEREST / BACKGROUND

Volunteer Background

Check all volunteer interests that apply: *

Development Support (assist w/ fundraising events & projects)
Gardening Support
Light Handy-Person Support
Make phone calls and/or visit homebound members
Organize an event / outing
Program Leadership & Support
Technology Assistance
Transportation (provide rides)

Other (please specify)

AVAILABILITY

Please specify times.

Availability - Monday

Availability - Tuesday

Availability - Wednesday

Availability - Thursday

Availability - Friday

For more information, please contact At Home on the Sound at 914.899.3150 or email Gloria Golle at director@athomeonthesound.org.

Thank you for choosing to volunteer with At Home on the Sound!!

REFERENCES

Please include name, phone, email, and relationship.

Reference #1 *

Reference #2 *

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