Volunteer Interest Form

First name

Last name

Phone

Cell phone

Number

Street

City

State

Zip Code

Friendly in-person visits

Future Service - MedPal - no ride necessary (companionship at a healthcare appointment)

Future Service - MedPal Plus - with a ride (transport and companionship at a healthcare appointment)

Future Service - “Rise and Shine” check-in calls

Handy Person (Light household chores in or outside of the house)

Light Technology Assistance

Ride not medically related

Ride to healthcare provider or pharmacy

Running errands medically related (non-transport)

Running errands not medically related (non-transport)

Budget & Finance Team

Core Team

Data & Evaluation Team

Events Team

Fundraising & Donations Team

Membership Team

Outreach & Communications Team

Volunteer Management Team

I confirm that I have read, consent and agree to Revolutionaging’s (Helpful Village’s) TERMS OF USE and PRIVACY POLICY

Thank you for your interest and we will be in touch with you very soon!