Please complete this application form if you are interested in becoming a Valley Senior Living volunteer. Once you complete the form, click the Continue button at the bottom.


Name and address


Emergency Contact


Demographic Information

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



Availability

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



Why Volunteer at Valley Senior Living?


Availability


References


HIPAA

Form will be emailed to you upon submission of this application.



Background Check

Form will be emailed to you upon submission of this application.



Signature


Agreement

I certify that the statements made in this volunteer application are true and correct. I understand by checking agree, this indicates my approval to complete a background check. I also agree to the rules and regulations of Valley Memorial Homes.

Valley Memorial Homes is not obligated to provide a placement, nor am I obligated to accept the volunteer position offered.

Opportunities for volunteers are provided without regard to religion, creed, race, national origin, age or sex.