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If you're interested in volunteering at Katella Senior Living, please fill out
and submit the form below and the Volunteer Coordinator will contact you!
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| First Name* |
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| Last Name* |
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| Mailing Address |
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| City |
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| State |
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| Zip |
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| Phone* |
Home
Cell
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| Email* |
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| Date of Birth |
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| Sex |
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How were you referred
to this facility? |
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What are your reasons
for wanting to volunteer? |
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Do you have any medical
restrictions which would
impact what you are
volunteering for? |
If yes, please list:
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Have you ever performed
volunteer services in a senior
living community before? |
If yes, where:
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Do you have any friends or
relatives employed or living
in one of our facilities? |
If yes, name:
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| What days are you available? |
Monday Tuesday Wednesday
Thursday Friday Saturday
Sunday
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What time of day would you
be available? |
Morning Afternoon Evening
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What hours are you looking
to volunteer? |
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Do you have any special
talents or hobbies you wish to
share with our residents? |
If yes, please describe:
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Do you play any musical
instruments or sing? |
If yes, what type:
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What type of services would
you be willing to provide?
Please number
in order of preference
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Special events/parties
Discussion groups
Volunteering one-to-one with a resident
Music groups
Reading to residents
Outings
Craft programs
Show movies, slides, etc.
Nail painting/manicures
Bingo, games, cards, puzzles, etc.
Virtual (web-based)
Other:
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| Emergency Contact Name |
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| Emergency Contact Phone |
Home
Cell
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| Emergency Contact Address |
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Questions/
Comments |
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