Become a Welcome Baby volunteer home visitor and enjoy the fulfillment of strengthening families in your community. Have fun interacting with parents and their new babies, bringing new information and activities while sharing insights from your personal experience. By volunteering five flexible hours each month, you can make a difference in the lives of families in Utah County!

Volunteers receive training in motor, language, emotional and cognitive development, home visitation, childhood dental health, infant massage, and much more.  This training occurs on the fourth Tuesday of every month from 9am-12pm at the Utah County Health Department.

Please fill out the form below and press the "submit" button to send us your information. If you have any questions, please contact our Welcome Baby coordinator at: 801-691-5304.

Name:     Date:

Birthdate:  Marital Status:  
Ethnicity:

Address:
City:    Zip:

Where have you lived outside of Utah County:


Home phone:    Work phone:   
Cell phone:

Can you be called at work?  Yes:  No:  

Email:

Do you drive?  Yes:  No:  
Driver License #:   State:

Do you have an automobile available to you?  Yes:  No:

Education:
High School: 9 10 11 12    College: 1 2 3 4    Graduate: 1 2 3 4

Major:    
Degree:

Are you presently enrolled in school?  Yes:  No:

If yes, please name school and your course of study:

Work/Volunteer History

1. Name and address of present or last employer or volunteer project:

Dates:   Supervisor:

Brief description of work:

2. Name and address of present or last employer or volunteer project:

Dates:   Supervisor:

Brief description of work:

Please list your other current activities and membership in clubs, churches or other organizations:

Languages spoken:

Experience with other cultures:

Are you an experienced parent, grandparent or child caregiver? Please Explain:

Do you have any training in any of the following areas?

If you answered yes, please describe:

If you have expertise in any area you feel would benefit the Welcome Baby Program that is not listed above, please specify:

Availability

Approximately how much time can you contribute monthly as a Welcome Baby Home Visitor?

How long do you think you will be available to volunteer as a home visitor?

Would you rather pick up families in central county (Provo, Orem), north county (Lehi, Pleasant Grove), or south county (Payson, Springville)?

Please write a brief statement explaining why you want to work with the Success By Six Welcome Baby Program.

Personal References

Please list two or more credible references we can contact to ensure the sustainability of our volunteers in the Welcome Baby program. Please list people who know you well enough to give credible feedback about your ability to work with others and their children.

Name:      Phone:       Relationship:

Name:      Phone:       Relationship:

Name:      Phone:       Relationship:

The persons listed above are reliable sources that I give approval to be contacted with regards to my service as a Welcome Baby Home Visitor.   Please print your name for verification: