MADISON SENIOR CENTER - Volunteer Application Form

Please complete this application form if you are interested in becoming a Madison Senior Center volunteer. Once you complete the form, click the submit button at the bottom.

Contact Information:

First name:

Last name:

Middle name:

Nickname:

Group name:

Street 1:

Street 2:

Street 3:

City:

State:

* Zip: *

Home phone:

* OK to call me here

Work phone:

OK to call me here

Cell phone:

OK to call me here

Email address:

Emergency Contact

First name:

Last name:

City:

State:

Home phone:

* OK to call here

Work phone:

OK to call here

Cell phone:

OK to call here

Email address:

Relationship:

Information About You

You may, provide the following information. It is used only to help us get a better idea of the demographic make-up of our volunteers.

Date of birth:

Gender:

Education:

Ethnicity:

Degree In:

Experience:

Average Individual Annual Income:

Disability:

Email Preferences

We like to keep volunteers informed of important news, schedules, and volunteer opportunities by email. However we will not send you any emails you do not want. Please un-check the box(es) below to opt out of the types of email message you prefer NOT to receive.

What kinds of email would you like to receive?

Volunteer Offers
Announces Overture Ticket Voucher availability and other volunteer recognition program offers.

Volunteer Program Information
Announces special Senior Center and volunteer events or activities.

Volunteer Recruitment Requests
Announces volunteer service opportunities at the Senior Center.

Volunteer Schedule Reminder
Reminds you of your upcoming shift or duties for which you have volunteered.

Availability

Please indicate the days and times you are usually available to volunteer. Please note that most of our volunteer roles serve between the hours of 8am to 4pm Monday to Friday.

Mon

Tue

Wed

Thu

Fri

From:

To:

Your Skills/Talents

Please check those skills or talents that you possess which you think would be of use to you as a Madison Senior Center volunteer.

Your Interests

Please check the volunteer categories listed below in which you have interest in volunteering at the Madison Senior Center.

References

Please provide two reference. At least one needs to be a professional or work reference such as an employer, a volunteer experience, or professor/teacher.

1

2

First name:

Last name:

Home phone:

OK to call here

Home phone:

OK to call here

Work phone:

OK to call here

Work phone:

OK to call here

Cell phone:

Email address:

Relationship:

Contacted:

Verified:

How did you learn about the Madison Senior Center?

Please note how you became aware of volunteer opportunities at the Madison Senior Center.

Volunteer Release Form

Liability Waiver:

I understand that my services are being offered on a voluntary basis without anticipation of financial remuneration. I shall indemnify and hold harmless the City of Madison, its Board and Commissions and their officers, agents and employees from and against all claims, demands, loss of liability of any kind or nature for any possible injury incurred during volunteer service.

Confidentiality:

I understand that Madison Senior Center volunteers are responsible for maintaining the confidentiality of all privileged information to which they may be exposed while serving as a volunteer. This information may include personal information about staff, participants and other volunteers or overall agency business.

Photograph Release:

Photos of volunteers and participants are taken periodically and used in promotional publications. You may excuse yourself from these by notifying the photographer that you do not wish to be photographed.

(NOTE: You will also have to physically sign this agreement upon becoming a Madison Senior Center volunteer)

I Agree