day of action for seniors - volunteer sign up

On November 3rd we will meet, gather our supplies and go and help senior citizens prepare for winter by raking leaves, cleaning gutters, and checking smoke detectors. It will be a day filled with hard work and many rewards. Please complete the following form so we can match you or your team with homes in your area.

Because we are sending volunteers to private homes of senior citizens, all volunteers must pass a background check in order to participate in this Day of Action.  EACH VOLUNTEER from your team must fill out a form.

Name *
Phone *
Please fill this field if you intend to sign up as part of a team.
This helps us match you with the rest of your team. Each member is required to fill out this form separately.
What is your job preference? *
Select one or more options.
What supplies would you be able to bring for your team to use? *
What is your availability? *
Where would you like to volunteer? *
Check all that apply:
Additional information required for background check.
Race *
Gender *
Date of Birth *
Date of Birth
Hold Harmless/Photo Release (if under 18, please have parent/guardian sign up) *
I hereby release, indemnify and hold harmless the United Way of Southwest Michigan, the participating United Way staff and volunteers from any and all liability in connection with the Day of Action for Seniors. I likewise hold harmless from liability any person transporting me to or from volunteer locations. In addition, United Way has permission to utilize any photographs or videos taken for publicity purposes and disseminate statements referring to me in conjunction with the event, authorizing any newspaper, company or other organization to publish, republish or exhibit said materials with or without identification of me by name in the promotion of United Way of Southwest Michigan. By Submitting this form you are agreeing to the above statement.

If you have any questions, please contact Jazna Stannard: 269-982-1700 ext. 22 or