Volunteer Application Become a Volunteer Today! Volunteer ApplicationYour Name(Required) First Last Your Address(Required) Street Address City StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State ZIP Code Home TelWork TelCellEmail(Required) Preferred Method of ContactEmailPhoneWho should we notify in case of an emergency?Emergency Contact Name First Last Emergency Contact Address Street Address City StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State ZIP Code Home TelWork TelCellTimes you are available:Please fill in the time available on the lines provided. Indicate specific time slots available between 9am and 5pm.Weekday MorningsWeekend MorningsWeekday AfternoonsWeekend AfternoonsPreferred location (Check all applicable)(Required) Bayside Nu‘uanu Pali Class Schedule:If you are a student, please fill in the days that you have school.SundayThursdayMondayFridayTuesdaySaturdayWednesdayOtherVolunteer Position you are most interested in:Check all that apply: Group Activities Assistant Volunteer Assist with our group activities to help engage our residents living with dementia. Provide motivation, good humor and a little extra help for those who need it. Companionship Volunteer (1:1, English or Bilingual) Become a friend to a person living with dementia. Offer conversation, friendship, and understanding. You will be paired with 1–2 specific residents to get to know and befriend. Musician/Entertainer Solo entertainers or groups are needed to perform our residents living with dementia. Please list any previous job or volunteer experience:Do you have any special hobbies, interests, skills, talents, or other experiences that you would like to share?Why would you like to volunteer at Hale Kū‘ike?To comply with the Department of Health requirements, all volunteers will need a 2-step TB test and a background check for those over 18 and out of high school.By submitting this applicationI affirm that the facts set forth in it are true and complete. I agree to abide by the policies of Hale Kū’ike for the health and safety of all.
