Smile on Seniors Volunteer Application

Name:
Address:
City: State: Zip:
Phone Number: Home Mobile
Email:

Are you affiliated with a synagogue? If yes, which one?

Volunteer Options (check one): I am able to visit 1 visit per week 2 visits per month for special events.

During your free time what do you like to do?
(Check all that apply)

Playing ball Playing Piano Reading Walking
Studying Cards Watching TV
Other:

When SOS has a program event, would you like to participate?
(Check all that apply)

Making Calls Setting Up Shopping
Planning At the Event Only
Other:

If you were a senior being visited, what are a few things that would interest you?

Thank you for taking the time to fill out this form. You will be contacted shortly by a Smile on Seniors coordinator.

For more information or any questions you might have please contact Chani at [email protected] or call 602.492.7670.