Pickens County
 Meals on Wheels

Serving the elderly of Pickens County       

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Pickens County Meals On Wheels Volunteer Application

Thank-you for your interest in volunteering! Please complete this form and then press Send button (at the bottom).  Our Volunteer Coordinator will contact you to talk more about your availability and to schedule volunteer training.

Special NOTE: press the tab button to move from field to field

Name:
Address:
City
State & Zip
Daytime Phone
Cell Phone
Email Address
Fax
Race
Sex
Birthday
In case of an emergency notify:
Name
Phone
Relationship
General Information
How did your find our about our Program
What is your church affiliation
Organization/Company
Volunteer Position (select one)	Driver Office/Clerical Special Projects Fundraising
Which day(s) of week are your AVAILABLE (List)
Briefly explain your previous volunteer Experience
Bearing in mind that we do not drive in snow or ice, are there any health restrictions that may affect your driving? Please describe.
In the last ten years have you had a DUI or DWI?	No Yes
Please list two references who are not related to you that we may contact.  Please include name, address, and phone number.
Photo Release
I hereby authorize Pickens County Meals on Wheels to release any photographs taken of me for any purpose related to promotion and well-being of PCMOW including, but not limited to newspapers, magazines, web pages, presentations and television: Yes No