Medical Respite Volunteer Form

VOLUNTEER APPLICATION

Hope of Glory Ministries encourages the participation of volunteers who support our mission with the homeless. If you agree with our mission and are willing to be interviewed and trained in our procedures, we encourage you to complete this application to volunteer with the medical respite program at the Center of Opportunity, 4550 S. Palo Verde Rd. The information on this form will be kept confidential.  Thank you for your interest in our organization.

The duties of this position will be to provide help to our patients (who are ambulatory) with basic needs, but will generally be for comfort, conversation and spiritual encouragement.  There may be a need for some minimal cleaning and bed changing.

Name: __________________________________________________

Address: ________________________________________________ City:_____________________ State:________

Zip:_____________ Phone: _____________________ Email: _______________________

Employer: ______________________ Position: _________________

Any special talents or skills you have that you feel would benefit the medical respite program?

_______________________________________________________________________________________________

­­­­­­­­­­­­­­­­­­­­­­­­­­­_______________________________________________________________________________________________

Any physical limitations? ____________________________________

A full week (Mon.-Sun.), hours (8AM-5PM), need to be covered. What 4-hour shifts would you be available?

­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­_________________________________________________________________________________________________

­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­References: _______________________________________      phone:_______________

_______________________________________        phone:_______________

In case of emergency contact: __________________________       phone: _______________

As a volunteer of our organization I agree to abide by its policies and procedures. I understand that I will be volunteering at my own risk and that the organization, its employees and affiliates, cannot assume any responsibility for any liability for any accident, injury or health problem which may arise from any volunteer work I perform for the organization. I agree that all the work I do is on a volunteer basis and I am not eligible to receive any monetary payment or reward.   Questions? Call Betty, 520-471-1720.  Please email application to: hisglory3@msn.com or mail to PO Box 91692, Tucson AZ 85752.