BEIT TIKVAH
GEMILUT CHESED VOLUNTEER INFORMATION

Date: ______________________

Name:____________________________________________________

Address: _________________________________________________________

Telephone : (home)______________(work)______________(fax)______________

E-mail: _______________________________ Age: _________________

Gemilut Chesed Activities

Would you like to serve as a Gemilut Chesed Committee Co-chair?
Yes
No

Would you like to serve as a Gemilut Chesed Committee Coordinator?
Yes
No

If yes, please check for which area(s) of service:
Home/Hospital Visit
Shiva Visit
Meals
Telephone Reassurance
Transportation
Other

III. Would you like to serve as a Gemilut Chesed Volunteer?
Yes
No

If yes, please check which area(s) of service activities you are interested in being called about participation:
Home/Hospital Visit
Shiva Visit
Meals
Telephone Reassurance
Transportation
Other

Thank You for Your Participation