Meals on Wheels Volunteer Application Form

• The Meal Site is located at Cedars, 35 Evergreen Ln., Queensbury, New York
• You may volunteer once a week or more often if your schedule permits
• Let me know what day or days' work best for your schedule
• It is about an 1 1/2 to 2 hour commitment on the day you deliver depending on the size of the route
• Meal deliveries start around 10:45am
• The meals are placed in 2 coolers one hot and one cold that go in your car for delivery
• Mileage is reimbursed
• When the local schools Close due to bad weather , we DO NOT deliver meals

Name:

Address:

Email Address:

Home Phone Number:

Cell Phone Number:

Birthday:

I plan on using my vehicle to deliver meals:

Yes No

I request mileage reimbursement for route miles:

Yes No

I would like to ride along with another volunteer and serve:

Yes No

I am presently a member of RSVP (Retired Senior Volunteer Program):

Yes No

I would like more information on joining RSVP:

Yes No

I would like to be a Substitute and am available:

Monday Tuesday Wednesday Thursday Friday

I would like to be a Regular and am available:

Monday Tuesday Wednesday Thursday Friday

How did you hear about the need for Volunteers for the home delivered meals program?:

Emergency Contact

Name:

Home Phone Number:

Cell Phone Number:

Send

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WARREN-HAMILTON COUNTIES
OFFICE FOR THE AGING
1340 STATE ROUTE 9 - LAKE GEORGE, NY 12845 DEANNA PARK - DIRECTOR TEL#(518) 761-6347 - FAX#(518) 761-6344
Volunteer Coordinator: Mary Ann McCarthy, PH#(518)761-6347