Champion Application

Step 1 of 3

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Support Level

Please check a box or boxes that apply.*

Adopt-A-Route

Yes, I would like to participate in Adopt-A-Route

No, I am not interested in Adopt-A-Route

An Aging Ahead Volunteer Coordinator will connect with your organization to discuss route options.

Support-A-Center

Bronze – $100/mo

Silver – $250/mo

Gold – $500/mo

*Support-A-Center requires a 6 month commitment

Support Family Caregivers

Bronze – $100/mo

Silver – $250/mo

Gold – $500/mo

*Support Family Caregivers requires a 6 month commitment

Name*

First Last

Phone Number*

Email*

Business/Organization Name*

Business/Organization Industry*

Business/Organizations Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

My organization has multiple locations or offices*

Yes

Additional Organizational Resources Available:

Check all that apply.

I’d like to subscribe to Aging Ahead’s newsletter

I’m interested in a educational workshop for my organization.

My organization would like educational materials for our office(s).

I am interested in a Lunch-and-Learn outreach presentation

Adopt-A-Route Application

Days Available

Monday

Tuesday

Wednesday

Thursday

Friday

Which locations(s) is your organization interested in serving?

St. Louis County

Affton

Ferguson

South County (Lemay)

West County

St. Charles County

O’Fallon

St. Charles

St. Peters

Wentzville

Jefferson County

Arnold

DeSoto

House Springs

Quad Cities

Franklin County

St. Clair

Sullivan

Union

Washington

In compliance with federal guidelines and to ensure the safety of our clients, please note that all volunteers must complete a background check.

Adopt-a-Route Agreement

In order to uphold the mission of Aging Ahead and protect the privacy and well-being of our participants, Aging Ahead requires that organizations committing to the Adopt-a-Route program abide by and agree to the following guidelines:

Organizations committed to this program are prohibited from collecting participant contact information.
Volunteers are prohibited from selling any product or service to participants while completing home-deliveries.
Volunteers are prohibited from distributing business cards, brochures, literature, etc. to home-delivered participants.
Volunteers of Aging Ahead shall conduct their personal affairs such that their duties and responsibilities to Aging Ahead are not jeopardized and/or legal questions do not arise with respect to their association or work with Aging Ahead.
All client information is confidential. To ensure the safety of our clients, please keep all information you may learn about a client confidential.
To uphold Federal guidelines, all volunteers must adhere to a thorough background check to help ensure the safety of Aging Ahead clients. If a background check was completed as required through your affiliated organization, please indicate below.

By signing this commitment agreement, you are stating that your business/organization is committed to delivering a midday Meals on Wheels route

Frequency*

Daily

Weekly

Bi-Weekly

Monthly

Other

All employees that volunteer delivering meals are required to comply with Aging Ahead’s background check requirement. If one of your teammates is unable to deliver the organization’s route on the agreed upon day, it is the responsibility of your organization to provide a substitute team member to ensure the route is delivered, whenever possible.

Date

MM slash DD slash YYYY

Team Leader Signature

Become a Champion

Support Level

Additional Organizational Resources Available:

Adopt-A-Route Application

Which locations(s) is your organization interested in serving?

Adopt-a-Route Agreement

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