Family and Elders Program Hour Log

Name*

First Last

Additional Family Member/s (If Applicable)

Names of all family members who volunteered. Please separate each name with a comma.

Number of Adult Volunteers*

Number of Youth Volunteers*

What is the name of the elder care community you visit?*

What dates are you recording volunteer time for?*

Put specific dates separated by commas or if you have kept to a consistent schedule you can put the date range and frequency here (example: every other Wednesday 1/1/2011-8/1/2011).

Number of visits*

Estimate the number of times you have visited since you last recorded your hours.

Average time spent at each visit*

Please list the name/s of the grandpartner/s you visited with.*

Include all elders you interacted with. Put elder's first name and the last name if known.