Volunteer Opportunites

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Volunteer

First Name
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Last Name
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Email
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Address
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Date of Birth
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Phone (day)
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Phone (night)
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Availability
Sunday
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Monday
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Tuesday
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Wednesday
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Thursday
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Friday
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Saturday
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Emergency Contact
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Why do you wish to volunteer?
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Do you have any prior experience working with individuals who have Alzheimer’s disease or related dememtia?
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Do you prefer individual activities or group activities?
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What skills, interests, or hobbies would you like to share with others?
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Have you ever been convicted of a crime?
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If yes, please provide date(s) and identify offense(s)
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Personal Reference 1 (Name, Address, Relationship, ad Phone Number)
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Personal Reference 2 (Name, Address, Relationship, ad Phone Number)
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Anti-Spam:(*)
Anti-Spam:
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