- Your Information
- Volunteer Agreement
Accept Text Messages?
Are you age 55 or over?
If YES, we will tell you about the benefits of being an AmeriCorps Senior volunteer!
Are you volunteering with a group?
Do you smoke?
I would prefer volunteer opportunities with a
Are you a military veteran?
Any allergies we should know about?
If you volunteer in a senior's home, would you prefer:
Will you be using your personal vehicle?
If you have insurance questions, these will be covered at your volunteer orientation.
Travel outside Washington County?
If using more than one personal vehicle, please list the additional vehicle's information below:
Please check all that apply or if you are interested in learning more!
Rides to critical services like doctor appointments, pharmacy, exercise, grocery store & food pantry.
Helping Hand Volunteer
I am interested in these individual "helping hand" opportunities.
Helping Hand Opportunities
I am interested in being part of a "Kindness Crew" group volunteer opportunity, call me when group opportunities become available for:
Opportunities at our health equipment lending program: customer assistance at the help Corner store in West Bend or Hartford, equipment repair & maintenance, warehouse, data entry, community awareness!
I am interested in volunteering at h.e.l.p. Corner in:
Other Volunteer Opportunities
I am interested in:
Days & Times
Please list the start/end times you may typically be available to volunteer for each day:
Please indicate how frequently you may be available to volunteer:
May we contact you to fill in for last minute requests? (ex. A driver is ill and cannot fulfill a ride obligation)
I am a member of a religious and/or civic organization
Background Information Disclosure
Please answer the following questions as completely and accurately as possible. Answering Affirmatively to any questions will not necessarily bar you from volunteering with Interfaith Caregivers of Washington County. However, failure to comply with these requirements, or providing false information, will likely result in denial or termination of volunteer activities.
Do you have criminal charges pending against you or were you ever convicted of any crime (not including traffic violations) anywhere, including federal, state, local, military and tribal courts?
If yes, list each crime, when it occurred or the date of conviction and the city and state where the court is located. You may be asked to supply additional information including a certified copy of the judgement of conviction, a copy of the criminal compliant, or any other relevant court or police documents.
Has any government regulatory agency (other than the police) ever found that you abused or neglected any person or client?
Has any government regulatory agency (other than the police) ever found that you misappropriated (improperly took or used) the property of a person or client?
Do you have a government issued credential that is not current or is limited so as to restrict you from providing care to clients?
Have you resided outside of Wisconsin in the last three years?
Thank you for your application to volunteer with Interfaith Caregivers of Washington County, Wisconsin.
Please read and agree to the following:
1) Please note that, if your application is accepted, you will be a volunteer and not an employee of Interfaith.
2) Criminal background checks may be conducted on volunteers. I authorize Interfaith to conduct such a check. All information collected during the check will be kept confidential.
3) I authorize the release of information to Interfaith related to my potential volunteer responsibilities and I release all parties from any liability resulting from the release of such information.
4) CONFIDENTIALITY: It is imperative that ALL information regarding an Interfaith service receiver be treated with the utmost confidence and such information may only be released to anyone (including family members) with proper authorization. These restrictions include all types of communication: verbal, written and electronic, including social media.
5) I agree to abide by all Interfaith policies and procedures during my participation as an Interfaith volunteer. Participation as an Interfaith volunteer may be terminated at any time due to failure to comply with Interfaith policies and procedures.
6) I release Interfaith, its employees, agents, volunteers, donors and sponsors from any and all claims resulting from my participation as a volunteer with Interfaith.