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Friendship Village Individual Volunteer Form

  • CONTACT INFORMATION: 

  • At which community would you like to volunteer?
  • (mm/dd/yyyy)
  • IN CASE OF EMERGENCY, PLEASE CONTACT:

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  • PLEASE CHECK AREAS OF INTEREST/SKILLS:

  • AREAS OF INTEREST:

  • PLEASE MARK THE DAY AND TIME YOU WISH TO VOLUNTEER:

  • Time of Day:
  • Opportunities for volunteers are provided without regard to religion, creed, race, national origin, age, or sex. The above information is accurate and correct to the best of my knowledge.  Friendship Village is not obligated to provide placement nor am I obligated to accept the position offered.

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  • PERMISSION FOR RELEASE OF INFORMATION FOR VOLUNTEER REFERENCE CHECKS:

  • do hereby grant permission for the below-named individuals and/or agencies to release information to Friendship Village concerning my character, employment, performance, skills, competence, and/or general ability.  It is understood that this permission includes cumulative and confidential information, which would assist Friendship Village in filling volunteer positions.

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  • I, do hereby certify that I am not registered on the Missouri Division of Aging’s Employee Disqualification List (EDL).

Friendship Village St. Louis Indepedent Living Facility Volunteers