HEART OF THE REDWOODS COMMUNITY HOSPICE

 

                            Volunteer  Interest and Contact Information

 

 

                  Name:___________________________________

                  Address:_________________________________

                  Phone:___________________________________

                  Location (neighborhood) where you live:__________________________________

           

                  Drivers license (if driving others):__________________________

                  Insurance:  ______________________________________________                                                                          

                  Experience or training in caregiving: ____________________________________________________

                  ______________________________________________________________________________________

 

 

                               Areas of Interest--check those that apply:

                 

                  __attending (sitting with someone)

                  __shopping

                  __errands

                  __driving to appointments     Local?      Eureka?

                  __plan/ prepare meals

                  __bathing

                  __dressing

                  __housecleaning

                  __yard work

                  __maintenance

                  __pet care

                  __be part of a monthly support group

                  __other: