Volunteer Application - St. Paul's Senior Services

First Name*

Last Name*

Today's Date(mm/dd/yyyy)*

Phone Number*

Email*

City*

Phone Type*
CellHomeWorkOther

Address*

Zipcode*

Occupation/Student*

Employer/School*

Date of Birth (mm/dd/yyyy)*

Are you 18 or older?*
YesNo

Applicants under 18 years of age need parental permission to volunteer with SPSS. Please see the consent form at end of application

Which language(s), besides English, do you speak?

Emergency Contact

Name*

Relation*

Phone Number*

How did you learn about St. Paul's?*

List any previous volunteer experience:

Organization

Details

Organization

Details

Organization

Details

Describe any special skills/hobbies you could share with our residents.*

Why do you want to volunteer for St. Paul's Senior Services?*

What location(s) are you interested in volunteering for?

South San Diego
Plaza (Memory Care, Assisted Living)
PACE Chula Vista

Central San Diego
Community Care Center (Child Care, Senior Day Care)
Villa (Memory Care, Assisted Living)
Manor (Independent Living)
McColl Health Center (Skilled Nursing Facility)
PACE San Diego

East San Diego
PACE El Cajon

Please indicate the times you are available to volunteer each day (ex: 9am-12pm). If you are not available on certain days enter "0".

Monday*

Tuesday*

Wednesday*

Thursday*

Friday*

Saturday*

Sunday*

Are you available and willing to commit to volunteering for a minimum of 6 months? If "No", please explain.*

Please review the following before submitting your application

My signature below acknowledges my understanding and responsibility to adhere to St. Paul's Senior Service's Confidentiality Policy. Read through the following statement and check the box below to agree:

As a Volunteer of St. Paul's Senior Services, I understand I may have access to information that is confidential in nature. I understand that this information is not to be shared with others who do not have a need to know, family, friends, or acquaintances. I understand that I am to maintain confidentiality of all information received when I receive, talk with, or overhear information on or about a resident or client. I understand I am to maintain the confidentiality of all records and record systems.

Required*
I Agree

My signature below acknowledges that I/we have read and understand the terms of this Release of Liability. Agreement, and agree to be bound by its terms. Click to view or download: Release of Liability Agreement

Required*
I Agree

My signature below acknowledges that I/we affirm that I/we have read the Statement of Good Health information and affirm that the person named below is in good health. Click to view or download: Statement of Good Health

Required*
I Agree

Volunteer Name*

Today's Date (mm/dd/yyyy)*

Volunteer Signature*

If you are under 18, please have your parent or guardian complete this section.

Parental/Guardian Consent Form:

I hereby allow my son/daughter/minor, for whom I am the guardian, to participate in St. Paul’s Senior Services
Volunteer Program.

Parent/Guardian Name

Today's Date (mm/dd/yyyy)

Parent/Guardian Signature

Experiencing difficulties with this form? Please report by emailing volunteers@stpaulseniors.org