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Eastside Neighbors Volunteer Program
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Volunteer Form

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  2. How to Volunteer
  3. Volunteer Form

    Volunteer Application

    "*" indicates required fields

    Step 1 of 4

    25%
    Name*
    MM slash DD slash YYYY
    Address*
    Please check services you'd like to offer*
    Thank you for your interest in ENVP, we are only accepting volunteer applications for the services listed above. Please choose at least one.
    Please check any additional services you'd like to offer
    Gender willing to serve*
    Allergies?
    Do you....
    What times are you available?*

    Transportation Info

    If offering to transport, please enter all the information below.
    Select all that apply*

    Emergency Contact

    References

    I give permission for the following personal references to be contacted:
    Consent*
    I acknowledge that in the course of providing volunteer services, I may have access to confidential information. I understand this information should remain confidential, and if I have concerns or questions about a recipient, I will contact my Program Director.

    Publicity Release

    Publicity Release
    I agree that Pima Council on Aging and/or the Neighbors Care Program may use the following purposes(please check each one). I understand that this publicity could include newspaper articles, television stories, a newsletter, flyers or brochures.

    Volunteer Transportation Service Only

    Designation of Beneficiary for Accidental Death Insurance.
    Address

    Neighbors Care Volunteer Application - Driver Form

    Transportation Agreement 1*
    I understand I will be volunteering my services with the Eastside Neighbors Volunteer Program (Neighbors Care Program) and as such, am not acting in the capacity as an employee of ENVP, Pima Council on Aging (PCOA), or RTA.
    Transportation Agreement 2*
    I understand that Eastside Neighbors Volunteer Program (Neighbors Care Program), PCOA or RTA are NOT liable for any accidents or claims which might occur during my volunteer activity. I agree that my personal automobile, or other personal insurance, covers me and any recipient I am transporting in my role as volunteer. I will maintain a valid driver’s license and arrange to keep in effect auto liability insurance equal to the minimum limits required by Arizona.
    Transportation Agreement 3*
    Transportation Agreement 4*
    I understand that I may be eligible for reimbursement for mileage expenses through PCOA and the Regional Transportation Authority (RTA).
    Transportation Agreement 5*

    Driving Record

    Have you been cited for any moving violations within the past 3 years?*
    Have you been cited for driving while intoxicated or for reckless driving within the past 3 years?*

    Volunteer Code of Conduct

    As a volunteer for the Eastside Neighbors Volunteer Program, Neighbors Care Program, I agree to the following guidelines for my interactions with recipients and volunteers.
    You must check each item*
    You must check each item*
    You must check each item*
    You must check each item*
    You must check each item*
    You must check each item*
    You must check each item*

    • I will not use the recipient's phone for personal calls;

    • I will not bring personal friends or relatives to the recipient's home;

    • I will not consume alcohol or smoke while volunteering;

    • I will not use the recipient's car.

    Clear Signature
    This field is for validation purposes and should be left unchanged.
    Eastside Neighbors Volunteer Program

    Address

    ENVP Office
    8302 Broadway Blvd.
    Tucson, AZ 85710
    ENVPCares@gmail.com
    (520) 245-4729

    Mon – Fri 10am – 2pm
    (Closed weekends and all Federal Holidays)

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