Volunteer Registration Form

If you prefer a print version, please download the following volunteer registration form (.pdf) and mail to:
Dutchess County Office for the Aging
114 Delafield St., Poughkeepsie, NY 12601

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* What type of volunteer activities are you interested in? (Check all that apply)

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* If you answered "Friendship Center Helper" in the previous question please indicate which center(s) Check all that apply

Your Contact Information

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* Last Name

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* First Name

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* Full Mailing Address (Street, Town, Zip Code)

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* Home Phone

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* Mobile Phone

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* Date of Birth (mm/dd/yyyy)

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* Email

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* Emergency Contact

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* Emergency Contact Phone

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* Please select all days you can be available

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* Please describe any medical limitations

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* Are you fluent in any foreign languages?

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* Briefly describe your technology skills

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* Previous volunteer experience

Because you may have direct contact with the elderly, the Office for the Aging may initiate inquiries into your personal history, including searches of police and motor vehicle files. By signing the form below you hereby grant the Office for the Aging permission to conduct any such search or investigation.

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* I accept

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* Your 9-digit NYS Driver's License ID Number

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* Today's date

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