Volunteer Sign-Up



Name________________________________________ Age:  ________

                                                          (Please print)                 

Phone (Home):   ______________________________AM / PM

              (Cell):    ______________________________AM / PM

             Email:     ______________________________



Please mark boxes to indicate interest/skill in specific areas.



q       Plumbing:  □ Basic    □ Intermediate      □  Advanced

q  Electrical:   □ Basic    □ Intermediate      □ Advanced

q  Carpentry:  □ Basic    □ Intermediate      □ Advanced

q  Help with “pre-staging” team



  General Skills/Interests:


q       Basic Computer

q       Home safety check

q       Shopping

q       Light House Cleaning

q       Running Errands

q       Transportation

q       Home Winterization

q       Grant Writing


q       Painting (Outside)

q       Painting (Inside)                  

q       Light Hauling                    

q       Clean up                                               

q       Car wash                               

q       Window wash                             

q       Yard Work


Visitation (Please indicate)

    □ Nursing Homes

    □ Home Bound

    □ Hospital

Other:  _______________






Please return completed form to:         Deb Shaw

                                                              12 Rigg Dr.

                                                              Lincoln, IL 62656