Visiting Angels Senior Registration 5/1/2025 - Samaritan's Feet International

Recipient First Name

Recipient Last Name

Recipient Cell

Recipient Emaila valid email

Recipient Gender

Recipient Ageyour full name

Event Wrap-Up

Event ID

Director

Your Email

Distribution Date

Shoes Funded

Shoes Distributed

Cityyour full name

Sponsor/Funding

Payment Information

Is payment complete?

YesNo

If yes, share payment details.your full name

If yes, how was it funded?

If no, what is the funding plan?

Volunteer Engagement

Complete # volunteers, # of hours, and comments for each of the following:

Shoe Distribution

Did you have volunteers for the shoe distribution?

YesNo

Shoe Distribution: # Volunteers

Shoe Distribution: # Hours

Shoe Distribution: Commentsmore details

0 /

Write Cards

Did you have volunteers write cards?

YesNo

Write Cards: # Cards

Write Cards: # Hours

Write Cards: Commentsmore details

0 /

Packing Party

Did you have volunteers at a packing party?

YesNo

Packing Party: # Volunteers

Packing Party: # Hours

Packing Party: Commentsmore details

0 /

Fundraising

Did you have volunteers fundraising?

YesNo

Fundraising: # Volunteers

Fundraising: # Hours

Fundraising: Commentsmore details

0 /

Event Planning Partner

Did you have volunteers with your event planning partner?

YesNo

Event Planning Partner: # Volunteers

Event Planning Partner: # Hours

Event Planning Partner: Commentsmore details

0 /

Shoe Drive

Did you have volunteers for a shoe drive?

YesNo

Shoe Drive: # Volunteers

Shoe Drive: # Hours

Shoe Drive: Commentsmore details

0 /

Shipment Information

Was your shipment on time?

YesNo

Was your shoe order accurate?

YesNo

Describe your shoe order inaccuracies.

0 /

Was your sock order accurate?

YesNo

Describe your sock order inaccuracies.

0 /

Was your supply order accurate?

YesNo

Describe your supply order inaccuracies.

0 /

Any comments about shipping?

0 /

Story Leads

Please describe a meaningful moment that occurred during your distribution. Or, is there a volunteer or recipient who experienced something impactful - if so, drop their contact information below and marketing will follow-up with them. Please also share any media links here.

Meaningful Story and/or Contactmore details

0 /

Photography & Videography

Please upload and photos or videos. Here are the recommendations:

Horizontally record videos for 1-minute

Vertically record videos for 1-minute

3 vertical pictures and 3 horizontal pics

Upload any photos here.

Upload File

Any additional comments for this event?

0 /

Employee Information

Name

Date

Travel Details

Nameyour full name

Estimated Travel Cost

Flight Cost

Airline

Rental Car Expense

Other Transportation

Meals

Any Other Cost

Specify

0 /

Approval

Manager

Manager's Signature

(Sign Here)

Clear Signature

Datemm/dd/yyyy

Personal Information

Nameyour full name

Date of Birthmm/dd/year

Phone Number(xxx)xxx-xxxx

Emaila valid email

Address

City

State

Zip Code

Emergency Contact Information

Name

Relationship

Phone Number(xxx)xxx-xxxx

Availability

Please indicate your preferred days and times for volunteering:

Preferred Times

MorningAfternoonEvening

Volunteer Interest

Please describe any relevant skills, qualifications, or previous volunteer experience that you feel would be helpful to our organization and why you feel you can serve as a Samaritan's Feet Ambassador.

Skills & Experience

0 /

Why do you want to volunteer with Samaritan's Feet?

0 /

Social Media Accounts

Xformerly Twitter

Facebook

Instagram

Reference 1

Name

Relationship

Phone Number

Emaila valid email

Reference 2

Name

Relationship

Phone Number

Emaila valid email

As part of our commitment to safety and security, we require background checks for all volunteers. Do you authorize Samaritan's Feet International to conduct a background check if necessary?

Declaration and Signature

I certify that the information provided above is true and complete to the best of my knowledge. I understand that volunteering with Samaritan’s Feet International may involve certain risks, and I agree to follow the organization's policies and guidelines while volunteering.

Datemm/dd/yyyy

SignatureI agree to the terms and conditions

(Sign Here)

Clear Signature

First Name

Last Name

Phone Numberyour full name

Commentsmore details

0 /

First Name

Last Name

First Name

Last Name

Phone Numberyour full name

Commentsmore details

0 /

First Name

Last Name

Are you representing or from a company or organization? If so, please input it below.

Company Nameyour full name

Comments

0 /

First Name

Last Name

Phone Numberyour full name

Commentsmore details

0 /

Name of Family/Individual, Business, School, Church, Etc.

Phone Number

We offer warehouse volunteer shifts on:

Tuesday-Thursday: 9:00am-12:00pm, 1:00pm-3:30pm

Saturday: 9:00am-12:00pm

Preferred Volunteer Date(s) MM/DD

Number of People in Your Group

Age Policy AgreementIn order to volunteer at Samaritan's Feet, individuals must be a minimum of eight years of age and must be chaperoned by an adult at all times. Please note that we require all minors to be chaperoned in a ratio of one adult to every five minors. By selecting yes, you agree to supply the required number of chaperones and to not bring minors in attendance under the age of eight.

YesNo

How many minors (age 8 - 18) will be in your group?

Comments

0 /

*Samaritan's Feet International does not offer volunteer hours for court ordered community service and staff is unable to sign off on documentation presented to them.

First Name

Last Name

Phone Numberyour full name

Commentsmore details

0 /

First Name

Last Name

Phone Numberyour full name

Commentsmore details

0 /

First & Last Name

Phone Numberyour full name

Commentsmore details

0 /

First Name

Last Name

Name of Family/Individual, Business, School, Church, Etc.

We offer pick-up and drop-off during the following times:

Monday-Friday: 9:00am-12:00pm or 1:00pm-3:00pm

Preferred Date(s) for Pick-Up (MM/DD)

Preferred Date(s) for Drop-OffNot to exceed two weeks past pick-up date.

Make and Model of Car

Will the trunk of the car be available?

YesNo

Will the back seat of the car be available?

YesNo

How many hours are you looking to volunteer?If exceeding six hours, please consider signing up for volunteer shifts in our warehouse.

Comments

0 /

Shoe Locker Pledge Form

Are you sponsoring as an individual or on behalf of a company?

IndividualCompany

First Name

Last Name

Phone Number

Company Name

Company Contact First Name

Company Contact Last Name

Company Contact Email

Company Contact Phone Number

Mailing Address

City

Zip

Desired City, State or School You Want to AdoptSamaritan's Feet cannot guarantee your desired school will be chosen.

Pledge

$5,000: 250 shoe commitment$10,000: 500 shoe commitmentOther

Other

Payment Method

Credit CardCheckInvoice

How did you hear about the Samaritan's Feet Shoe Lockers?

I agree to the above by signing below.

SignatureI agree to the above.

(Sign Here)

Clear Signature

Emaila valid email

I'm thankful for Samaritan's Feet because...more details

0 /

Fileupload

Upload Photo, Video, Etc.

New Shoes for Seniors in Columbus, OH

Payment Information

Volunteer Engagement

Shoe Distribution

Write Cards

Packing Party

Fundraising

Event Planning Partner

Shoe Drive

Shipment Information

Story Leads

Photography & Videography