Volunteer Intake Form

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    Pressing "enter" or "return" submits the form.
    Personal information
    • Okay to call at work
    Availability
    • WeeklyEvery Other WeekMonthlyAs NeededSubstitute Only
    • MorningAfternoonEveningDuring the WeekWeekends
    • SpringSummerFallWinter
    • Do you routinely leave the area for an extended time at a particular time each year?
      NoYes
    Health
    • YesNo
    • CigarettesPipeOther
    • You must abstain while recipient present.
    • DogsCatsBirds
    • No Pets
    Transportation
    • YesNo
    • CarTruckSUVVanOther
    • YesNo
    • City BusTaxiBicycle
    Volunteer Matching
    • Please provide any information about yourself that will help in finding a lasting match.
    • In what geographical area(s) are you willing to volunteer?
      NorthsideSouthsideOnalaskaHolmenWest SalemBangor
    • Please list any special training or skills you may have that pertain to volunteering:
    • YesNo
    • Share any additional information here:
    SERVICES INTERESTED IN
    • Arts Buddy   Schedule available online or by mail - $2.50 per performance, tickets at Causeway
    • Sports Buddy   Attend College or Logger sports events with your match, expense of ticket
    • Errands   Bank | Post Office | Repair of Item | Pharmacy | Veterinary | Medical Appointments | Etc.
    • Shopping  Grocery | Clothing | Shoe | Household Items | Pet Needs | Health/Pharmacy | Holiday | Etc.
    • Are you willing to...?
      Shop from a list onlyOffer assistance in the storeCarry bagsPut items away
    • Indoor Home Chore Wash Windows | Storm/Screen | Light Bulb| Garden/Bushes | Light Repairs | Etc.
    • Materials needed must be supplied or paid for by recipient. Volunteer not responsible for any cost
    • Outdoor Home Chore Wash windows | Raking | Snow/Ice Treatment | Wedding | Pruning | Etc.
    • Causeway does not allow the use gas powered tools unless volunteer and recipient assume responsibility.
    • Reading Read a book, newspaper, magazine| Find Books on Tape | Library Outings | Etc.
    • Writing Correspondence | Assistance writing letters | Assistance writing seasonal/occasion cards
    • Bookwork Sorting Mail and Papers | Organizing Papers for Payment | Filing | Correspondence | Etc.
    • Visits Phone calls | Crafts | Baking | Cards/Board Games | TV Program/Movie | Scrap booking | Etc.
    • Outings  Drives | Food/Coffee | Points of Interest | Social Events | Movie | Parks | Walk | Church | Etc.
    • Causeway Office Volunteer | Newsletter | Fundraisers | Committee | Church Representative
      As a volunteer within Causeway Interfaith Volunteer Caregivers, Inc. you share your time and talents by being matched with a person who has requested a volunteer. In order to ensure volunteer safety and the quality of our mission work, we ask you to please read and respond to the following questions.

    • Do you and will you maintain health insurance for yourself?
    • Do you and will you maintain vehicle insurance?
    • We screen all Volunteer and Recipient background information
    • YesNo
    • YesNo
    • YesNo
    • YesNo
    • YesNo
    • YesNo
    • Note: Failure to volunteer within guidelines may make you ineligible to volunteer.
    • captcha

    We thank you for your participation in Causeway Caregivers! 

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