Thank you for your interest in volunteer opportunities at Neighborly Care Network! Please complete this application form to be considered. Our minimum age to volunteer is 18 and Neighborly does not accept court-ordered community service volunteers. Once you complete the form, please click the I AGREE button at the bottom.

PLEASE read the following carefully:

Spouses/partners or members of a group/employer who intend to serve together on an ongoing basis should complete their own individual application and choose an orientation date.
Neighborly's programs and volunteer opportunities are Monday through Friday only, generally between 10:30am and 2:30pm. Some positions start earlier.
Please be sure to use proper capitalization as this application does not auto correct.
Meals on Wheels volunteer opportunities fluctuate by site as we rely on the dedication of volunteers. We will do our best to accommodate your request for a specific location but these are always changing.

Thank you!

Contact Information

First name:

Last name:

Street 1:

Street 2:

City:

State:

* Zip: *

Home phone:

OK to call me here

Cell phone:

* OK to call me here

Email address:

Demographic Information

Please provide the following demographic information used only for funding agency requirements.

Date of birth:

Age:

Gender:

Ethnicity:

Availability

Please indicate the days and times you are usually available to volunteer. Generally, volunteers generally serve between 10:30 AM and 2:30 PM.

My availability is:

From:

to:

Email

Email is the only way our small staff are able to effectively and efficiently keep our volunteers informed of important policy and procedure updates as required by our funders, therefore our ability to communicate with you via email is required. The system will only send you a reminder of the orientation you choose if you choose schedule reminders.

Assignment Preference

Please select the role or roles that interest you. You can click on each to see its location and description.

Orientation

Attendance at orientation is required prior to service. PLEASE read this carefully and select the correct orientation session you wish to attend below. Orientations are held at our Administration office located at 13945 Evergreen Avenue in Clearwater.

Orientations marked Transportation Drivers are for those interested in transporting seniors to medical appointments, not Meals on Wheels
For those interested in Adult Day Center opportunities (entertainers, site assistants and pet therapy), please choose a date that indicates Adult Day Center only
Those interested in Meals on Wheels, Dining Site, or Pantry can choose any of the other orientation dates.

Times

Assignment

Emergency Contact

In the event of an emergency, whom should we notify?

First name:

Last name:

Home phone:

* OK to call here

Cell phone:

* OK to call here

Relationship:

How did you hear about us?

If you choose "other" please provide specifics below.

How did you hear about us?:

If you chose other & please list any limitations:

Group name (if applicable):

If you are an individual who will serve as part of a group/employer/church, etc. please list the group here.

I AGREE

I understand and agree that:

Submitting this application does not automatically register me as a Neighborly Care Network volunteer, and that there may be certain qualifications I must meet, including orientation, training, a background check, and the acceptance of established policies and procedures, before I may begin volunteering.
I attest that I am at least 18 years old.
I am not court-ordered to perform community service.
The information I have provided on this form is true and accurate. I understand if the information submitted is not accurate, I may be dismissed from volunteer service.
I agree to keep all information regarding clients confidential per HIPAA requirements.
I consent that Neighborly Care Network and other authorized representatives of Neighborly be allowed to use my: name, title, portrait, picture, video image, photograph, or any reproduction or likeness of me or quotation of my remarks, for public information and fundraising purposes. Permission is hereby granted to use personal information about myself and the circumstances of my relationship with Neighborly Care Network as deemed appropriate by Neighborly Care Network. I understand that the above likeness and/or remarks may appear in the following: social media posts, television, radio, publications of Neighborly Care Network, newspaper articles about Neighborly Care Network and its programs such as may be published in the print media, advertising for programs of Neighborly in brochures, leaflets etc. I warrant that I have reached the age of legal majority according to the laws of the state of Florida. I further state that I have not been adjudicated incompetent and that no legal guardian has been appointed for me. If you do not grant permission to Neighborly to use your name, title, portrait, picture, video image, photograph, or any reproduction or likeness or quote from you, you must include this in the Limitations form section in this application prior to clicking "I agree" and the Continue button below.
If I am choosing to volunteer for Meals on Wheels, I agree I have downloaded, read, will keep as a reference, and comply with the orientation documents and Volunteer Handbook as posted on the Neighborly web site's volunteer page.

I Agree