Group Name


Address


Contact Person


Phone Number


Fax Number


Email Address


Has your group volunteered with us in the past?
yes no

If yes, at what site and when?


Would you like to receive our newsletter?
yes no

How many volunteers do you expect?


Will you provide your own meals (if applicable)?
yes no

What type of skills does your group possess?
i.e.- carpentry, landscaping, electrical...


Does anyone in your group require special accommodations?
i.e.-handicap ramps, cannot stand long,
no heavy lifting, or no stair climbing
yes no

If yes, what are those accomodations?


If children will be a part of the group what ages are they?


Will there be supervision provided by your group?
yes no

Would you prefer to volunteer at a specific site?
yes no

If yes, please indicate which sites you prefer.
Gannett House Maximize Hillcrest House
LaGrange House DCCH River Haven
Administrative Offices

Will you provide supplies if needed?
yes no

Please indicate your areas of interest.
Clerical assignments, mailings
Landscaping, yard work
Small scale painting
Holiday parties for clients
Recreational activities with children
Cleaning, organizing
Tutoring
DCCH Adopt-a-Meal
DCCH Adopt-a-Night
Other