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Volunteer Application

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Date: *

MM/DD/YYYY

Name: *

First Name and Last Name

Phone Number: *

Street Address: *

City *

State: *

Zip Code: *

Email: *

Frequency of Time You'd Like to Volunteer: *

Length of Time You Wish to Volunteer: *

Time Preference: *

Days of the Week You'd Prefer to Volunteer: *

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Check the Areas in Which You Would Be Interested: *

VISIT with patients
READ with patients
RUN ERRANDS for patient/caregivers
SIT with patients while caregivers run errands or respite care
PLAY music or instrument in facility rooms
LIGHT HOUSE KEEPING for patients at home
ASSIST WITH YARD WORK for patients at home
SOJOURN sit with alone patients during transition and passing
OFFICE ASSISTANCE at Heritage Hospice mailings, filings, phone calls, and special projects
CRAFT PROJECTS to use as gifts for patients: knitting, crocheting, other

Heritage Hospice

1202 W. Buena Vista Road
Evansville, IN 47710

812-475-9712

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