HILLVIEW HEALTH CARE CENTER
Best Time To Call:
Emergency Contact (name and phone number):
References: (only one may be a relative; list names and phone number with area code)
Background Check: (Every volunteer is subject to a background check as Hillview does not accept volunteers with any
cases of theft or abuse.)
II. This section for college students only.
Class requiring volunteer hours:
Hours required for classwork:
Frequency with which you wish to volunteer. (check preference)
Weekly (1,2, or 3 days)
Every Other Week
IV. Time Preference/Skills/Abilities. (check preference)
9:00 a.m. - 1:00 a.m.
1:00 p.m. - 4:00 p.m.
6:00 p.m. - 8:30 p.m.
ALL VOLUNTEERS MUST GO THROUGH A 1-HOUR ORIENTATION SESSION.
Days of the Week Preferred:
Any skills, hobbies, or previous experiences you would like to share:
Any physical limitations:
If yes, please explain:
V. Possible Areas of Work Preference (Please mark your preferences.)
Help with Parties
Provide Instrumental Talent
Provide Vocal Talent
Help In Making and Putting Up Decorations
Taking Residents for Walks/Rides/Outings
Transporting Residents To Activities
Helping To Prepare for Special Events (Christmas, Halloween, Valentines, etc)
Book Cart (Distributing Books/Magazines/Puzzles)
Play Music/Read/Simple Games for Room Bound Residents
Help With Programs for Low Functioning Residents (Creative Stimulation, Lounge Program)
Work with the Resident Rooms
Teach a Special Talent (Drawing, Knitting, etc)
Assist During Craft Projects/Woodworking
Friendly Visits to Residents Rooms
Assist Exercise Group
Ladies Fingernail Painting
Bulletin Board Ideas
By submitting this form, I understand that it is my responsibility to keep confidential any information I learn about the residents and/or their family, and that violating confidentiality is cause for immediate dismissal.