VOLUNTEER APPLICATION

If you prefer to fill out the application and bring it to the office, click here.  
 
Date*
Name*
Birthdate (mm/dd/yyyy)*
Address*
City*
State*
Zip Code*
Home Phone*
Cell Phone
Email*
Previous Volunteer Experience (Where, Years of experience, Responsibilities)
Reference (Name, Phone, Years known)
Any physical limitations affecting volunteer placement? If yes, please explain.*
Emergency Contact, Relationship, Phone*
Doctors Name, Phone
Please select any position that you are interested in. Most shifts are Monday - Friday (unless indicated)* Driver (10:00 am - 12:30 pm)   
Kitchen Pack/Serve meals (8:00 am -1:00 pm)  
Reception Desk (10:30 am - 1:00 pm)   
Entertainment during lunch (11:15 am –12:45 pm) 
Thrift Store #1 (9:15am-11:45pm)   
Thrift Store #2 (11:45am-2:30pm)   
Office (Various hours)   
Special Events (Various day/hours; including weekends)   
Special / specific skills you are willing to contribute
What is your availability? Please select all that apply. Weekly on a scheduled basis 2-5 hrs   
Weekly on a scheduled basis 5-10 hrs   
Weekly on a scheduled basis 10+ hrs 
Special Events (Various day/hours; including weekends)   
What days are best for you? M T W Th F*

Prescott Meals On Wheels       928-445-7630        pmow@cableone.net