Thank you for your interest in volunteering with the In Service of Seniors or Open Your Heart to a Senior program, and helping older adults in our community remain independent in their homes.

Please complete the following form and we will contact you to arrange an in-person or virtual training (approx. 1 1/2 hours) before we match you up with a senior.

Please list TWO non-family members (friend, teacher, employer, clergy, etc) who have known you for at least one year who we may contact as character references.

Fill out the following fields ONLY IF you will be driving senior care receivers in your car.

Our team works hard to help you get matched with opprotunities that will be a good fit for you.  The following questions are to better assist us with the matching proess.

Pledge of Confidentiality

 I am volunteering my time to help carry out the work of the In Service of Seniors/Open Your Heart to a Senior programs.  I understand that in the course of my volunteer work and experience I may learn certain facts, including protected health information, about individuals I help that are of a highly personal and confidential nature.  Examples of such information include medical conditions and treatment, finances, living arrangements, employment, relations with family members, etc.  I understand that all such information must be treated as completely confidential.  I agree not to disclose any information of a personal and confidential nature to any person other than In Service of Seniors staff members.

 Having read this pledge, I understand and agree to abide by the In Service of Seniors/Open Your Heart to a Senior policy on confidentiality.

 I understand that failure to comply may result in my immediate dismissal as an In Service of Seniors/Open Your Heart to a Senior volunteer.