Volunteer Application MOW Wake County

Having the right information is important in the continued operations of our program, and we ask that all of our volunteers and participants of our volunteer program to please take the time to fill this form out in its entirety prior to beginning to volunteer with us.

Our volunteers generally come in to deliver hot meals to our clients at 10:30 and can expect to spend up to 2 hours working with us per visit, Monday thru Friday. For this, a personal vehicle is required.

Your privacy and security is important to us and as such, all personal information will remain private within Meals on Wheels of Wake County.

1 Start 2 Complete

Your Contact info

First Name *

Last Name *

Street Address *

City *

State *

Zip Code *

Home Phone *

If your home phone is the same as your cell phone, just put the same number in both fields.

Cell Phone *

Work Phone *

Preferred Contact Number *

Home

Cell

Work

Email *

Emergency Contact info

Emergency Contact First Name *

Emergency Contact Last Name *

Emergency Contact Phone Number *

Emergency Contact 2 First name *

Emergency Contact 2 Last Name *

Emergency Contact 2 Phone Number *

Reference Info

Reference First Name *

Reference Last Name *

Reference Phone Number *

Reference First Name 2 *

Reference Last Name 2 *

Reference Phone Number 2 *

Drivers License and Insurance Info

Driver's License Number *

Expiration Date *

Month

Day

Year

State issued *

Date Issued *

Month

Day

Year

Insurance Company *

Insurance Policy Number *

Policy Expiraiton Date *

Month

Day

Year

Is your volunteer interest in order to fulfill community service hours? *

Yes

Have you ever been convicted of a felony? *

Yes

Liability and Confidentiality

STATEMENT OF LIABILITY - Meals on Wheels of Wake County is not responsible for personal injuries or property damage suffered or caused by volunteer in connection with his or her volunteer activities. As a condition to serving as a volunteer, each volunteer is expected to maintain his or her own insurance covering these and other risks.

Liability Acknowledgement *

Type your name below, as it appears at the beginning of this form, to agree to the above statement.

CONFIDENTIALITY STATEMENT - It is understood that as a volunteer of Meals on Wheels of Wake County, you will protect the privacy of all those we serve by maintaining strict confidentiality when disucssing meal recipients and the nature of their health conditions. Under no cirumstances should a volunteer from Meals on Wheels of Wake County divulge recipient information to anyone outside the organization.

Confidentiality Acknowledgement *

Type your name below, as it appears at the beginning of this form, to agree to the above statement.