Good Samaritan House

Volunteer Application
Date Training Completed______________
GENERAL INFORMATION
Name_________________________________________________________________________________
Address_______________________________________________________________________________
Phone Number (____)___________________________
Are you volunteering: Individually______

Organization_______________________________________

Emergency Contact: Name__________________________________ Phone Number_________________

How did you hear about the Good Samaritan House? ___________________________________________
Are there any medical conditions we should be aware of? Yes__ No__ If yes, please explain ___________
______________________________________________________________________________________
SPECIAL INTERESTS/TALENTS (check all that apply)
__ Childcare

__Maintenance work

__ Secretarial work

__ Fundraising

__ Grant writing

__ Tutoring children __ Tutoring adults __ Cooking __ Crafts (children or adults) __Other

Would you be willing to do a workshop for the residents on any of these topics?
__ Budgeting __ Computers __Nutrition __ Exercise __ Cooking __ Cleaning __ Childcare
Do you have any past experiences that would benefit the shelter? _________________________________
______________________________________________________________________________________
Have you had any experience working with the homeless? __Yes

__No If yes, please explain

______________________________________________________________________________________
______________________________________________________________________________________
How often would you like to volunteer? ___ Daily ___ Weekly ___Monthly ___ Other_____
Which days would you be able to volunteer? ________________________ __Days __ Evenings
When would you be able to attend volunteer training? (check all you are able to attend)
___ Monday

___ Day

___ Evening

___ Thursday

___ Day

___ Evenings

___ Tuesday

___ Day

___ Evening

___ Friday

___ Day

___ Evenings

___ Wednesday

___ Day

___ Evening

___ Saturday

___ Day

___ Evenings

___ I am available any of the days and times listed above.

Consent
I agree to submit to a background check to ensure the safety of myself, other volunteers and staff, and Good
Samaritan House residents.

Signature______________________________________ Date____________