Volunteer Recruitment Form
Thank you for your interest in volunteering for Interlakes Community Caregivers! > Return to Homepage
Choose all that apply
Choose all that apply
Choose all that apply
Choose all that apply

Emergency Contact

In the event of an emergency, please let us know whom we should notify.

References (required)

Please list names, addresses, and telephone numbers of two adults (not members of your family) that we may contact for personal character references:

Acknowledgement

In completing this application, I agree that all information is correct to the best of my knowledge and understand that ICCI will maintain confidentiality as to any information shared on this application.
Use your mouse (or touch screen) to create a digital representation of your actual signature. If you need help signing your name, please call 603-253-9275 or email us at [email protected] for assistance.