Volunteer Now
Date you can start:
First Name:
Middle Name:
Last Name:
Home Phone:
Work Phone:
Cell Phone:
Maiden Name:
Ailases:
Date of Birth:
Mailing Address:
City:
State:
Zip Code:
Snowbird Information (If Applicable)
Address:
City:
State:
Zip Code:
Emergency Information
Name:
Phone Number:
Spouse Information
Name:
Phone Number:
Weekdays you can Volunteer
Mon.
Tue.
Wed.
Thur.
Fri.
Eskimo Squad
Are you willing to deliver meals during periods of heavy snow fall?
Yes
No
Do you own a reliable 4-wheel drive vehicle for use for the above?
Yes
No
Questions
Have you ever plead guilty to or been convicted of a misdemeanor or felony (excluding minor traffic violations)?
Yes
No
(If Yes, please set forth the details including the nature of the offence, date and jurisdiction.)
Have you ever been listed on the DFS Abuse/Neglect Central Registry?
Yes
No
(If Yes, please set forth the details.)
(A Yes answer to either of the preceeding questions does not automatically disqualify you from being a volunteer with Meals On Wheels. The Nature and date of the offence will be taken into consideration.