Volunteer Intake Form

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Personal information
  • Okay to call at work
  • 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?
  • YesNo
  • CigarettesPipeOther
  • You must abstain while recipient present.
  • DogsCatsBirds
  • No Pets
  • 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:
  • 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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