Volunteer Activity Options

Please check all that apply.

__Driving Meals On Wheels                          Please indicate the area you would like to drive.

__Assisting Driver                                           _______________________________________         

__Office Work at Central Kitchen

__Kitchen Work at Central Kitchen

__Maintenance (painting, carpentry etc.) at Central Kitchen

What is your availability?

 DAYS:            Mon.____       Tues.____       Weds.____      Thurs.____     Fri.____

 Safety/Security Questions

1.                  Do you have a valid driver’s license?                     Yes_______  No______

2.                  Do you have car insurance as required by State? Yes_______  No______

3.                  Have you ever been convicted of a felony?            Yes_______  No______

I hereby affirm that the information provided in this application for volunteer service with Meals On Wheels of Northwest Indiana, Inc. is true and correct to the best of my knowledge.

I understand that Meals On Wheels of Northwest Indiana, Inc. does not discriminate on the basis of race, color, sex, religion, national origin, ancestry, citizenship, age, physical or mental disability or sexual preference.  I further understand that no question on this application is intended to secure information to be used for such discrimination.

I further state that if I am applying for driving a delivery route for Meals On Wheels, I have a valid driver’s license and current automobile insurance. 

I will not hold Meals On Wheels of Northwest Indiana, Inc. responsible for anything that may happen to my person or property while engaged in the activities associated with my volunteering for the above named Agency.

I have read and understand the above.  I agree to abide by the terms.

Signed_________________________________________________________________

Date___________________________________________________________________

CONFIDENTIALITY STATEMENT

The clients of Meal On Wheels of Northwest Indiana, Inc. have the right to their privacy.  It is the responsibility of every volunteer to respect and protect that right, and to maintain client confidentiality at all times, both during the service period and after.

Toward this end, all volunteers should refrain from discussion of our clients, their conditions or any phase of their personal affairs other than with the necessary agency personnel needed to provide the service to them. 

As a volunteer, I will dispose of the delivery route sheet that contains client information according to the direction of the Agency.

I have read and understand the above.  I agree to abide by the terms.

Signed__________________________________________________________________

Date____________________________________________________________________