FORMS | LV/SD MOWs

VOLUNTEER APPLICATION

( Fields marked with an asterisk* are required )

Last Name

First Name

Street Address

City

State

Zip code

Phone ( E.g. 909-596-1828 )

Emergency Contact

Emergency Contact Phone Number

As a Meals on Wheels volunteer, if you are 55 or older, you qualify to become a Aging Next volunteer. Additional information will be provided at your orientation.

If you will be a driver: I have Bodily Injury Liability automobile insurance coverage of at least $50,000 per accident. If at any time the above coverage changes, I agree to immediately advise La Verne / San Dimas Meals on Wheels.

Driver's License Number and Expiration Date

Or Click box for I will not be a driver for La Verne / San Dimas Meals on Wheels

La Verne / San Dimas Meals on Wheels strongly upholds the strictest level of volunteer and client confidentiality. All information, personal or otherwise, regarding clients, volunteers, and the operations of Meals on Wheels is to be kept confidential and may not be shared with outside parties without express written consent. Information or knowledge of customers, volunteers, or other parties affiliated with Meals of Wheels used for financial gain or other unauthorized or unethical causes is strictly forbidden.

I agree that failure to reveal pertinent information, or giving of false or misleading information by me, may be grounds for termination of my volunteer assignment.

Thanks for applying to volunteer with us ! We will get back to you soon