Volunteer Application Form

Online Volunteer Registration

Preferred Site (may choose more than one)(Required)

GreenField Health &
Rehabilitation Center Skilled Nursing & Rehabilitation
5949 Broadway

GreenField Manor/Court Independent/Assisted Living
5953/5951 Broadway

GreenField Terrace Enhanced Assisted/Memory Care
5979 Broadway

Name(Required)

First Last

Date

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone

Cell Phone

Work Phone

Email(Required)

Cultural Information - Optional Question (for statistical purposes only)

How did you find out about The GreenFields?

Do you have any volunteer experience?(Required)

No

Yes

Please describe your volunteer experience.

List any hobbies, special interests or skills you have or would like to share with our residents:

Are any of the residents, volunteers or staff members - friends or relatives of yours?

No

Yes

If yes, please list them and their relationship to you:

Do you have any physical or medical limitations that would affect your ability to complete certain tasks?

No

Yes

Please explain your physical or medical limitations:

Have you ever been convicted of a crime?

No

Yes

Please provide details of the conviction(s):

Would you please share with us?

Name of Church

Priest/Minister/Rabbi

Address

Street Address

In the event of an emergency, please notify:

Name

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

I hereby sign that all the above information is true and accurate. Any false information will result in termination of my volunteer services.

Name

First Last

Date

CAPTCHA

As a volunteer you are eligible for:

Free meals from the GHRC employee cafeteria if you work during meal times
Free flu shots during flu season & Yearly Health Assessment and PPD Series
Volunteer name badge
Invitation to the Annual Volunteer Appreciation Luncheon
The opportunity to join the Niagara Lutheran Health System Guild (minimal annual donation)
The fulfillment of helping others!

Any questions?
Contact: Mary Dumke, Development & Volunteer Coordinator
(716) 684-0202, ext. 1802 or email: mdumke@niagaralutheran.org

Niagara Lutheran
Health System

Online Volunteer Registration

In the event of an emergency, please notify:

I hereby sign that all the above information is true and accurate. Any false information will result in termination of my volunteer services.

Niagara Lutheran Health Foundation

What's Happening:

Contact Us

Follow Us

Volunteer Application Form

Niagara Lutheran Health System

Online Volunteer Registration

In the event of an emergency, please notify:

I hereby sign that all the above information is true and accurate. Any false information will result in termination of my volunteer services.

Niagara Lutheran Health Foundation

What's Happening:

Contact Us

Follow Us

Niagara Lutheran
Health System