Volunteer Application

If you want to become a volunteer, please fill out the form below to begin the process. If you have questions concerning volunteering, you can contact our Volunteer Coordinator MaRita Alexander.

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Volunteer Information

Days Available for Meal Delivery

Monday

Tuesday

Wednesday

Thursday

Friday

Drivers Information

Drivers License Number

Drivers License Issue State

Drivers License Expiration Date

YYYY

Drivers Insurance Company

Drivers Insurance Policy #

References

Reference # 1 Name

Reference # 1 Phone

(###)

###

####

Reference # 1 Email

Reference # 2 Name

Reference #2 Phone

(###)

###

####

Reference #2 Email

Additional Information

Tell Us Why You Want To Volunteer For Meals On Wheels

Emergency Contact Name

Emergency Contact Phone #

(###)

###

####

Agreement and Signature

Volunteer Statement, Confidentiality and Liability Waiver

I agree to the Volunteer Statement, Confidentiality and Liability Waiver:

I Agree

I Do Not Agree

Type Full Name (Digital Signature)

Date of Application

YYYY