Adventures in Caring

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If you are interested in becoming an Adventures in Caring Volunteer please fill out this online application form. When you are finished, just click submit and the form with be emailed to us automatically.

Or would you rather print out the application form and send it to us via regular mail?

REQUEST INFORMATION

Fill out the form on this page and click submit and we will get back to you as soon as possible.

Name:	Today's Date:	Date of Birth:
Street Address:	City, State, Zip:
Home phone:	Work phone:	E-mail:
Driver's License #:	DL State:	Social Security #:
Employer (School & Year, if a full-time student):
Permanent address (if a full-time student):		Permnt. phone:

1. Previous experience and education in the health/helping professions, and/or volunteer work:

2. Have you experienced a severe illness and been hospitalized yourself? If so, for how long, how often?

3. Have you ever visited family or friends in a hospital or nursing home? If so, when and how often?

4. How did you find out about the Raggedy Ann & Andy program?

5. Why are you interested in this program?

6. How do you feel about your ability to listen and communicate, especially during the emotionally difficult situations which frequently arise during illness, injury, aging and dying?

7. If you have ever participated in any programs or practices which emphasize personal or spiritual development, please mention those you found most meaningful:

8. Raggedy Ann & Andy volunteers make a commitment to visit nursing homes at least once a week, for 2 hours. Please indicate which day(s) of the week you would be available to volunteer. After the day please show the time of day you prefer: morning, afternoon or evening:

Mon Tues Wed Thurs Fri Sat Sun

9. Which volunteer training seminar can you attend? (Seminar dates and times.)
Date:

10. List three references who know you well (not your family or Adventures in Caring staff.) These people should be aware of your communication skills, and either your work in the health/helping professions or your volunteer work.

i. Name:	Phone:
Address:	City:	Zip:
ii. Name:	Phone:
Address:	City:	Zip:
iii. Name:	Phone:
Address:	City:	Zip:

Next of kin (in case of emergency):
Name:	Phone:

11. I understand that not everyone is well-suited to volunteering as Raggedy Ann or Raggedy Andy, and that attending the volunteer training seminar does not guarantee my being accepted into the Raggedy Ann & Andy Visiting Program. This decision is made by the Adventures in Caring training staff, and depends on one’s suitability as the character Raggedy Ann or Raggedy Andy, and on adequate interpersonal skills. If I am not accepted into the program, I will receive a full refund of the training fee.

Accept Decline

Raggedy Ann and Raggedy Andy are trademarks of Simon & Schuster, Inc. and are used by Adventures in Caring with permission. Licensed by United Media.