get involved: volunteer information form

Volunteering Information

Employer/College/High School *

If applicable, briefly describe your job, profession or major course of study:

Have you ever done volunteer work before? *

Yes
No

If so, where and describe your experience: Is there any particular area of volunteer work you would like to get into through Beverly Farm? If so, please describe: How many hours per week would you be available to volunteer? * Do you have any favorite hobbies or special skills (non-job related)? If so, please describe briefly:

Do you enjoy working with persons with disabilities? *

Yes
No

Do you enjoy working with the public? *

Yes
No

Do you have transportation? *

Yes
No

INDICATE AREAS OF INTEREST:

Therapeutic Horsemanship
Shopping Complex
Activities/Field Trips with Residents
Horticulture
Special Events
Friendly Visits
Seniors
Ceramics

Your Personal Information

Your Name *

Address *

City *

State *

Zip *

Daytime Phone Number *

Evening Phone Number *

Email Address *

6301 Humbert Road, Godfrey, IL 62035618-466-0367618-466-3652 (fax)

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Commission on Accreditation of Rehabilitation Facilities