Volunteer at Ivy Lodge Assisted Living

Volunteer Application

We appreciate you taking the time to fill out this application. The information you provide will assist us in an appropriate volunteer opportunity that will match your skills and interests.

Name

First Last

Preferred Name

Mailing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone

Best Time To Call

Work Phone

Best Time To Call

Cell Phone

Best Time To Call

Previous Volunteer Experience

When Are Your Available To Volunteer (weekdays, weekends, mornings, evenings)? Please Be As Specific As Possible.

Emergency Contact

Person To Contact In Case Of Emergency

Relationship

Phone Number of Emergency Contact

Skills & Abilities

Please indicate which skills and abilities you would be interested in sharing with us. (You may select more than one)

Music

Exercise

Games

Food

Plant Care

Arts & Crafts

Lectures

Special Events: setup and teardown

Other Skills & Abilities

PPD (Tuberculosis Test) will be required

CAPTCHA

Call: 845-246-4646

Call: 845-246-4646

Volunteer Application

Emergency Contact

Skills & Abilities

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