Retired Senior Volunteer Program - RSVP Lawrenceburg, IN Chapter!

RSVP VOLUNTEER REQUEST FORM

Please fill out the form below and then press the SUBMIT button when finished. Required fields are indicated with a red asterisk. We will receive the form via email and contact you via phone or email.

If you prefer, we have a printable form which you can open, print , fill out, and then fax or mail to us. Printable version
requires Acrobat Reader. Open Printable Form ---- Get Adobe Reader

Name * required

Birth Date * required

Address * required

City/State/Zip* required

Email Address * required

Phone * required

If you drive, are you confident and comfortable behind the wheel? YES NO

Have you ever been convicted of a felony?
* required

How did you hear about RSVP?

Do you have any physical limitations?

Below is an Interest Survey. Please select any roles or responsibilities that interest you. Select as many as you wish.

Carpentry

Construction
Handyman
Small Projects
Woodworking

Environment

Beautification
Gardening
Conservation
Pollution
Recycling

Mailings

Assembling
Attach Labels
Hand Address
Sorting

Sewing/Crocheting/Knitting

Crocheting
Hand Sewing
Knitting
Machine Sewing
Quilting

Clerical

Accounting
Bookkeeping
Computer Data Entry
Filing
Telephone calling
Receptionist
Typing

Health/Human Needs

Children
Drug Prevention/Ed.
Hospital
Immunizations
Independent Living
Nursing

Nursing Homes/Shut Ins

Activities
Patient Visitations
Pet Visitations

Special Interest

Animal Lover
Board Membership
Genealogy
Musical Entertainment
Kitchen Band
Performing Arts
Topic Presentations

Community Events

Organizing
Staffing a Booth
Setup / Cleanup

Homeless/Housing

Rehab
Self Sufficiency
Shelters

Nutrition

Cook/Serve Meals
Education
Food Bank
Meal Delivery

Shut-Ins

Driving/Giving Rides
Shopping
Telephone Visitation

Education

Adult
Elementary
Middle/High School
Pen Pal
Preschool

Literacy/Reading

Adults
Children
Library Help

Public Safety

Crime Prevention
Elderly Safety
Fire Safety
Scams

Crafts

Door Decorations
Home Projects

Other Interests (please specify)

Beneficiary Section

As an RSVP member, you are automatically entitled to a $2500 accidental death benefit to the beneficiary of your choice.
Please enter beneficiary information below:

Name:* Relationship:* Phone:*

Address,City,State,Zip:*

* entire Beneficiary section required!

Photo Release: RSVP (Retired Senior Volunteer Program) has my permission to use general information about
my volunteer work, and to use any photographs taken of me while volunteering, for promotional purposes for the RSVP program.
I have read this release statement and agree with the terms as stated. --- I agree I disagree

RSVP P.O. Box 4194 / 98 East High Street Lawrenceburg, IN 47025 Ph. (812) 539-4005 Fx. (812) 539-2362
©2009 Retired Senior Volunteer Program. All Rights Reserved. Site maintained by Stapleton Electric Co.