How To Become A Volunteer

Volunteer Signup Sheet

Please fill out the form below or download and print a form to be mailed to:

Josh Klein Bikkur Cholim Society
c/o Marilyn Klein
116 Woodridge Drive
Harrisburg, PA 17110
717-545-8796
Marilyn@JoshKleinBCS.org or use the form below

Email Address:
*required

Name:
*required

Street Address:

City:

State:

Zip:

Home Phone:

Work Phone:

Cell Phone:

I. Please check areas of volunteer interest:

Available to visit all local hospitals

Only interested in specific hospitals:
Carlisle Harrisburg Hershey Medical Center Holy Spirit
Lebanon Osteopathic Polyclinic Seidle Memorial York

Available to visit out of town hospitals:
Philadelphia Baltimore New York Other

Interested in visiting people in other types of institutions:
Jewish Home Non-sectarian nursing homes and retirement communities
Homebound Hospice Jewish Group Home
I am willing to house relatives

Time available for volunteering (list hours):

Monday Tuesday Wednesday

Thursday Friday Sunday

Do you drive?: Yes No Do you have a car?: Yes No

II. Please check other volunteer activities:

I am able to donate blood: Yes No Blood Type

I am willing to cook for a family:
Weekday Shabbat Meal Cook and deliver to out of town hospital

I can translate:
Hebrew Russian Yiddish Other

I am willing to:
Babysit Shop Help with Homework

Please list any special talents, skills, or hobbies that would be helpful to Bikkur Cholim:

Please list three references:

Name

Phone Number

Comments:

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