Woods Services Volunteer Application

	Personal Information Name * Date of birth * Address * City * State * Zip * Telephone (Home) * Telephone (Work) Email Address How and when do you prefer we contact you? * How did you learn about Woods? * Why do you want to be a volunteer? * Current and Previous Volunteer Experience Organization Duties Dates Work Experience (start with most recent employer) Employer Duties Dates Skills Hobbies & Interests Personal Reference Name * Phone * Relationship * How long known * Are you a member of a volunteer organization (RSVP, Rotary)? yes   no Name of organization Are you a Woods Services employee? yes   no Department: Job Title: Supervisor: Extension: In which of the following volunteer opportunities would you like to participate? Buddy Program: Frequent and regular visits with a resident to spend time doing activities, playing games, etc. Afternoon/Evening Activity Program: Participate in activities, games, and crafts with the clients in their residences (Times range between 3:30pm and 9pm). Pet Therapy: Trained volunteers and certified pets visit with residents. Special Events: Visitors’ Day: Assist with lunch & activities on Visitors’ Day Secret Santa: Purchase items for residents whose families cannot buy gifts When would you like to participate in these programs? Start Date: Finish Date: Person to Notify In Case of Emergency Name * Phone * Relationship *

In accordance with laws adopted by the Commonwealth of Pennsylvania, all new volunteers at Woods Services must have Childline Clearance and Criminal History Clearance.

Pennsylvania law requires that volunteers have periodic health screens on file in their medical folder.  New volunteers are required to have a health screen that includes a TB skin test and drug screen.  Volunteers must have an updated health screen on file every two (2) years.

Once your application is reviewed, you will receive the documents listed above and will be asked to schedule a physical exam with our Health Services physician.  Once these items are complete, you will be permitted to begin volunteering.

Thanks again for your interest!  If you have any questions, please contact the Volunteer Office at 215-750-4244.

I have read and agree to the terms and conditions described above and hereby submit my application.