Full Name(Required)

Birthday

MM slash DD slash YYYY

Address

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

Email(Required)

Primary Phone(Required)

Secondary Phone

Best Time to Call

Emergency Contact Name

Relationship

Address

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

Home Phone Number

Cell Phone Number

Business Phone Number

Please check which of these prompted you to apply for volunteer service for the MSC or Stonebridge

A Current or Past Client

MSC or SCS Volunteer/Staff

Another Source

Please Elaborate

Please tell us why you want to volunteer for the MSC or Stonebridge

In which areas of volunteer services are you interested?

Meals on Wheels Driver

Transportation Driver

Tutor

Exercise Instructor

Activity Leader (Pickleball)

Which geographical area would you prefer? (MOW & Exercise Instructors only)

Tillsonburg

Straffordville/Eden

Norwich/Burgessville/Otterville

Other

Availability (Please check the days you are available)

Monday

Tuesday

Wednesday

Thursday

Friday

Availability (Transportation Program ONLY)

Morning

Afternoon

Evening

Saturday

Sunday

How often are you available to Volunteer?

Are you available to fill in for last minute cancellations?

Does anyone smoke in your vehicle?

What drives do you prefer?

Would you consider training to drive our Wheelchair Accessible Van?

How do you prefer to be reimbursed for your mileage?

References Name

Relationship to You

Phone

References Name

Relationship to You

Phone

References Name

Relationship to You

Phone

We will require a formal vulnerable police records check for all volunteers and possibly a current driver's abstract at the expense of the MSC. By providing your e-signature below, you hereby certify that all information included in this application is true.

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Volunteer Application