Friends in Deed Volunteer Application

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CORE Community Resources
14 South Broad St
PO Box 1530
Bayfield, WI 54814
715-779-3457 | office@corecr.org | www.corecr.org

Email *

Name *

Birthdate *

YYYY

Address *

Phone Number *

Email Address *

Emergency Contact (Name, Phone Number, and Email) *

Services I would be willing to provide

Regular Welfare Checks

Light housekeeping / Laundry

Meal preparation

Help with pet care (dog walking, vet visits, etc.)

Shopping and errands (with or for care receiver)

Transportation to and from medical appointments or social outings

Computer assistance (email, hardware, etc.)

Friendly visiting

Assistance with paperwork, contacting insurance companies, Medicare, etc.

Yard work

Snow removal

Minor Maintenance Help

Mowing lawn

Other:

Clear selection

If you are willing to provide transportation, please answer the four following questions

You will need to provide proof of valid auto insurance. Please bring a copy of your insurance card to your orientation.

1. Which state(s) do you hold a driver's license?

2. Driver's license number

3. Do you have any driving restrictions?

Yes

Other:

4. Do you have liability insurance equal to or greater than the minimum limits required by the State of Wisconsin and agree to keep that coverage on your auto while volunteering?

Yes

Other:

Background Information Disclosure

In order to maintain liability Insurance, CORE is required to perform background checks on all volunteers. By entering your initials in the 'other' box below, you are effectively providing your signature, indicating that all the information on this form is true and accurate, to the best of your knowledge.

1. Were you ever known by any other names (including married or maiden names). If yes, what names have you used? *

2. I understand under penalty of law that the information provided above is truthful and accurate to the best of my knowledge. I also understand the screening requirements mentioned above, and authorize CORE Community Resources to process the paperwork for the criminal background check and driver's license check. *

Yes

Other:

Required

Liability Coverage

By entering your initials in the 'other' boxes below, you are effectively providing your signature, indicating that all the information on this form is true and accurate, to the best of your knowledge.

General Liability: I understand that I may not have coverage for my activities as a volunteer for CORE. *

Yes

Other:

Required

Bondability: I understand that I am not bonded and that I should not handle money or property for the care receiver or the care receiver's family. *

Yes

Other:

Required

Auto insurance: I understand that I must provide my own automobile insurance and that CORE’s insurance does not necessarily provide coverage for me. *

Yes

Other:

Required

Submit

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