Service Group Application Form
Thank you for your interest in volunteering at SourcePoint. Please complete this application and click the 'Continue' button at the bottom. We look forward to working with you!
Group Information
Group Name:
*
# of members:
Participation:
If your group will serve more than once, you will usually send...
The same volunteers each time
Different volunteers each time
What is the age range of your group?
Group Contact Information
Please enter information for the contact person for your group.
First name:
*
Last name:
*
Title:
Choose
Dr.
Mr.
Mrs.
Ms.
Rev.
Street 1:
City:
State:
Choose
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip:
Home phone:
Cell phone:
Email address:
*
Volunteer Involvement
How frequently would your group like to volunteer?
Group Preferences
Let us know in which of the following service opportunities your group would like to participate:
* Leaf Raking - at our senior clients' yards
* Group Home Chores - exterior chores for senior clients
* Event Assistance - wait staff, leading games, setup/cleanup
* Craft Projects - centerpieces, favors for special events
* Birthday Cards - creating birthday cards for homebound seniors to be delivered by volunteers
Your group's preferences
Equal Volunteer Opportunity/Agreement
Opportunities for volunteers are provided without regard to race, color, religion, sex, national origin, veteran status or physical ability. I attest that all the information furnished in this application is true, accurate and complete to the best of my knowledge. I understand that if chosen to volunteer, any misstatement or omission of fact on this application is cause for immediate removal. I authorize SourcePoint to verify any information I have provided by contacting appropriate sources. I release reference sources from all liability or damages on account of furnishing information regarding my personal character, habits, performance or disciplinary records. I further understand that if accepted as a volunteer at SourcePoint, my volunteer service may be terminated at any time, at the option of either SourcePoint or me.
I understand that if any members of this group wish to enter a client's home or wish to volunteer individually, they will need to participate in SourcePoint's volunteer orientation process, including a background check.
Checking the 'I Agree' box below serves as your signature.
I Agree
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