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Journey Home Singers Volunteer Application

Thank you for your interest in becoming a singer for Journey Home Bedside Singers, a volunteer program associated with VNA & Hospice of Cooley Dickinson. Please take a few moments to complete this application. When you click “Send,” it will be sent to our Volunteer Coordinator, Tina Leflar.

Note that recruitment and acceptance of new members is based on our needs at the time. Should our positions be filled, we will let you know and put you on our waiting list for future opportunities.

Please note: Journey Home singers must be at least 18 years old. VNA & Hospice does not discriminate on the basis of race, color, national origin, religion, disability, sexual orientation, gender identity, or age in admission or access to treatment or participation in its programs or activities.

    Date

    Mr.Mrs.MissMs.

    First Name

    Middle Name

    Last Name

    Street Adress

    City

    State

    Zip

    Home Phone

    Business/Cell Phone

    Email address

    Confirm email address

    Can you be contacted at work?
    YesNo

    Occupation

    Please tell us something about yourself:

    Why do you want to be a Hospice volunteer singer? What do you feel you would bring to the program?

    What have been your personal experiences with serious illness, loss (may include divorce, job loss, etc.) and death? How did you react in these situations?

    Please Give a Brief Summary of Your Musical Experience:

    REFERENCES

    Please list two References (Name, address, phone, email).

    1 | Name

    Address

    Phone

    Email

    2 | Name

    Address

    Phone

    Email

    I give permission for Cooley Dickinson Health Care to contact the references listed above (check box to agree)

    If you would prefer to download and print your application, please click HERE, then email or mail it to our Volunteer Coordinator, Tina Leflar, at the contact information below. Once reviewed, she will contact you about next steps.

    SEND APPLICATION TO:

    Tina Leflar
    Hospice Volunteer Coordinator
    VNA & Hospice of Cooley Dickinson
    Phone: 413-584-1060
    Email: cleflar@cooleydickinson.org