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  1. MSC Logo 3C
  2. Membership and Volunteer Application

    The Middleton Senior Center tracks participation in programs as well as volunteer hours.  Please complete this form and you will be given a key card to swipe each time you come into the Senior Center. 

    --Please stop by the Center to pick-up your member keycard. It will be ready within 1 week of submitting your membership application--

  3. Emergency Contact Information:
  4. Volunteer Opportunities

    Please select all that apply

  5. Training Skills

    Please select all that apply

  6. Any Physical Limitations?

    Please select any that apply

  7. References - Please list two references not related to you whom we may contact:
  8. Reference #1
  9. Reference #2
  10. All volunteers of the Middleton Senior Center shall maintain confidentiality in the handling and use of participant information and records.  Any information relating to individuals attending programs or activities at the Middleton Senior Center is not to be discussed at any time within or outside the Middleton Senior Center.  This information may include personal information about staff, participants or overall agency business.

    --Please stop by the Center to pick-up your member keycard. It will be ready within 1 week of submitting your membership application--

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  12. This field is not part of the form submission.