CITY OF BOWIE
NEIGHBORS HELPING NEIGHBORS
VOLUNTEER APPLICATION
As a public service and in an effort to assist senior citizens and residents with a disability, the City
maintains a list of adult volunteers who have offered their time. Senior citizens and residents with a
disability who are in need of assistance with grocery shopping and pharmacy pickup will be provided
with the names of individuals who have volunteered to assist them. For additional information
contact Lori Cunningham at (240) 544-5601. If
you are available to provide services to those in need
please complete this application and email it to lcunningham@cityofbowie.org or return
it to:
Neighbors Helping Neighbors
Bowie City Hall
15901 Excalibur Road
Bowie, MD 20716
VOLUNTEER DATA
(Please Print):
Name: Date of Birth: ___________________
Ex. 01/05/1955
Phone #: (H) (C)
Address:
Street City State
Zip Code
Email Address:
SERVICE(S) Offered – Please Check
Grocery Shopping
Pharmacy Pickup
I agree to participate in the City of Bowie’s
Neighbors Helping Neighbors program. I understand that the City will run a criminal background
check but otherwise does not interview or pre-screen volunteers or residents requesting assistance
with respect to physical or mental illness or condition, or any other adverse personal information.
The City encourages both
parties to interview each other by phone or in person before deciding
to continue. The City assumes no responsibility
for the quality of services to be rendered nor does
it assume any liability for any act or omissions ensuing
from or related to the referral or services
rendered in connection with referrals.
It is my responsibility to
ensure that any job I accept is safe and appropriate.
I release and discharge the City of Bowie
from all claims , demands, actions, and causes of action
for damages or losses for personal injury, including death, or property damage, in any manner
arising from or in connection with my participation in this program, including but not limited to
damages arising from illness or infection developed by me or a third party as a consequence of
my participation in the program. The City appreciates all follow-up comments from both
volunteers and those requesting help.
Signature:
Date:
Printed Name:
click to sign
signature
click to edit
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