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Volunteer Application

Name:
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Address:
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City:
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Zip Code:
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Home Phone:
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Cell Phone:
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Email Address:
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Do you have any medical conditions we should be aware of?
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If yes, please list:
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Are you 18 years of age or older?
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Emergency Contact:
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Emergency Contact Phone:
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Current Job or Last Work Experience:
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Tell us about your...
Experience with Older Adults:
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Volunteer Experiences:
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Hobbies and Interests:
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What led to your interest in Evergreen Retirement Community?
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Please provide two references.
Reference #1 Name:
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Reference #1 Phone:
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Reference #1 Relationship:
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Reference #2 Name:
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Reference #2 Phone:
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Reference #2 Relationship:
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Availability (please check all that apply):
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Please check the areas of service that are of interest to you:







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For Pet Therapy Volunteers Only:

My pet is current on all required vaccinations:
Electronic Signature:
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(please type your full name)

Date:
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