Continuing Care Retirement Communities - Smith Senior Living

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Volunteer Application Form

Items marked with a "*" are required.

*Name:

First

Last

If you are part of an organization please enter it here:

*Address:

*City:

State:

*Zip Code:

*Daytime Phone:

Home Office

Cell Phone:

*Email:

I am a student, 18 or under, attending School and I am seeking to fulfill service hour requirements.

I Learned about this volunteer opportunity from:

Resident

Staff member

Neighbor

Publicity

A group in which I'm involved

I would like to volunteer at:

Smith Crossing

Smith Village

Both Smith Crossing
and Smith Village

PLEASE FILL OUT THE INFORMATION BELOW
I am interested in volunteering because:

I would be most interested in: (Select all that apply)

The Arts	Crafts	Lifelong Learning
Painting classes	Crocheting, Knitting	Book club
Musicals discussion	Photography	Computer skills
Piano lessons		Current events
Theater group	Fitness	Foreign languages
	Tai Chai	History discussions
Just Fun	Yoga	Library cart
Board and card games
Comedy nights		Personal Services
Dance lessons	Campus Services	Pet Therapy
Gardening club	Gardening	Reading to residents
	One-day seasonal landscaping clean-up	Transportation within the community

Special Skills, Hobbies, Interests

Other volunteer experience

I prefer to volunteer with the community of residents in:

Independent Living

Assisted Living

Alz / Memory Support

Skilled Nursing

Schedule Preferences

Frequency Once only Once a week Once a month As needed

Day of Week Sun Mon Tue Wed Thur Fri Sat

Time of Day

Morning Afternoon Evening

*In order to be a volunteer, I understand that an orientation meeting is required and some training may also be necessary.