Youth Volunteering Application - Jewish Social Services

If you are under age 18, please fill in our online form below or download our application here.

Online Applications

• Regular Volunteer Application
• Regular Youth Volunteer Application
• Short-term Volunteer Application
• Short-term Youth Volunteer Application
• What is a short-term project?

Your Information

First Name:

Last Name:

Gender:

Male

Female

Address:

City:

State:

Zip:

Birth Date:

Age:

Home Phone:
Cell Phone:
Email Address:

What is the best way & time to reach you?

United Way

We receive United Way funds & are required to collect certain statistics, which are reported by category; volunteers' names are never provided.

Race:

Are you disabled?

Yes

Education & Interests

School:
Grade:

Previous Volunteer Experience; list agencies and what you did:

Hobbies & Interests:

Groups, clubs, organization memberships (include offices & positions held:

Languages you speak:

Location Preferences:

References

These are acceptable: employers, including baby-sitting, volunteer supervisors, teachers, clergy, coaches; (friends & relatives are not). We suggest getting the references' permission to use their name. At least one reference should be local. List name, phone number & their relationship to you.

Name	Phone Number	Relationship to You

Preferences

Will someone be able to drive you if necessary or can you take the bus?

Yes

When are you available? Take into consideration your school, Hebrew school & activities schedules:

Monday -	From:	To:
Tuesday -	From:	To:
Wednesday -	From:	To:
Thursday -	From:	To:
Friday -	From:	To:
Saturday -	From:	To:
Sunday -	From:	To:

Your Volunteer Preferences (check any that apply):

	Friendly Visitor - regular visits to an individual who is home-bound, to reduce isolation, as needed
	First Friend - establish a relationship with an individual with a disability, as needed
	Run errands for an individual who is house-bound
	Telephone reassurance
	Deliver Hanukkah menorahs to seniors in nursing homes & assisted living facilities
	Community Senior Passover Seder
	Move donated furniture and household items.
	Have a vehicle to assist with moving furniture & household items
	Computer assistance, as needed
	"Blackout" boxes for seniors and people with disabilities.
	Spring flowers or herbs planted in flower pots.
	Yard work and gardening
	Back-to-school backpacks for Jewish students in need.
	Pen pal to an elder or person with disability.
	Raise funds for JSS programs through car washes, yard sales, etc.
	Collect food and/or toiletries for JSS clients
	Care packages for US military forces stationed abroad.
	Other:

Any Additional Comments:

Please read the following carefully before you sign this application.

I certify that the statements made by me are true and correct, to the best of my knowledge. I will not withhold information that might affect my application for a volunteer position, and I understand that misrepresentations or omissions may be cause for my immediate rejection as an applicant for a volunteer position with Jewish Social Services, or my termination as a volunteer. I grant permission to Jewish Social Services to verify documents I submit and statements I make. I agree to release and hold harmless from liability any person or organization that provides information, as well as Jewish Social Services. I understand that this is an application and not a commitment or promise to provide me a volunteer placement with JSS.
Volunteer Confidentiality - I have discussed and understand the need to protect the privacy of Jewish Social Services of Madison (JSS) and its service recipients, and agree to respect the confidentiality of all client information that I observe and am privy to as a volunteer of JSS. All information regarding individuals is to be kept within the confines of JSS, its programs and/or facilities. Client information is to be discussed only with JSS social service staff. Additionally, confidential health information is to include all information past, present or future that may reveal something about the individuals' physical and/or mental health.

In the event of an emergency I should call 911.

If I observe anything regarding a JSS client that concerns me, this confidentiality agreement requires that I report it as soon as possible to the social service staff at 608-278-1808, during office hours (Monday-Friday, 9:00-5:00).

Confidentiality extends to all public relations material. Volunteers may not discuss JSS clients with any form of media, without prior approval of JSS. The information in Jewish Social Services volunteer records is to be discussed only with JSS social service staff.
Photographic Release, Information Release, and Parental Permission - I have received permission from my parents to provide my personal information, quotes, and photographs which may be used as part of Jewish Social Services' promotional materials and news coverage. I understand that this appliction will be kept confidential.

	I agree to the above terms and conditions.
	My parents agree to the above terms and conditions.