Volunteer Form Full Name (required) Phone (home): Phone (work or cell) Address City State Zip Your Email (required) Emergency Contact Emergency Phone Volunteer or Work Experience What are your expectations of volunteering for the VNA? How did you hear about the VNA of Somerset Hills? Please check when you are available to work: Weekdays Weekends Evenings PLEASE PROVIDE TWO REFERENCES: Reference 1 Name Address Phone Reference 2 Name Address Phone Confidentiality Notice: Your privacy is very important. Although we apply safeguards, information sent via the internet has no guarantee of security. This form should not be used to communicate confidential health information to the VNA of Somerset Hills. The VNA of Somerset Hills shall not be liable for any breach of confidentiality resulting from such transmission.