Please complete this application form if you are interested in participating in the summertime Gracedale Nursing Home Junior Volunteer Program. This application should only be used by junior and high school students.

Once you complete the form, click the Continue button at the bottom.

Name and address

Demographic Information

Current High School

Work Experience

Volunteer Experience


Please indicate the days and times you are usually available to volunteer.



Emergency Contacts

Email Preferences

We like to keep volunteers informed of important news, schedules, and volunteer opportunities by email, however will not send you any email you prefer not to receive. Use the checkboxes below to select the kinds of email you would like to receive from us.