Name     

Address  

City        

State      

ZIP         

Phone    

  daytime  evening

I would prefer to volunteer in

Burnsville

Minnetonka

Shakopee

Victoria

I can volunteer:

One time only

Daily

Weekly

Monthly

Other

I am available:

Mornings

Afternoons

Evenings

Specific times

Please list specific times.

I am available on these days:

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

I can assist with the following activities:

Scheduled activities led by staff

One-on-one work with individual residents

Special events (parties, holiday celebrations, etc.)

Religious gatherings

Other, subject to facility approval

I can share the following special skills or talent:

Play a musical instrument

Sing

Crafts

Nail Care

Storytelling

Cooking

Slide Shows

Games

Cards

Religious services

Notes:

(include musical instrument, religious service denomination or other talents you would like to share)

What is your motivation for serving our residents?

Additional Comments: