Please complete this application form if you are interested in becoming an Adult Volunteer, Foster Grandparent, Chaplains' Assistant or Johnson Auxiliary Volunteer at Regional One Health. (Alternative Spring Break/Volunteer Groups, please complete this form, if your volunteers are eighteen (18) or older.)

Volunteers must be at least 18 years of age. Volunteers must have good interpersonal skills, exemplify a positive demeanor, are service oriented and support the vision and mission of Regional One Health. As with all volunteer opportunities here at Regional One Health, after all application materials are completed and submitted, each applicant must pass a background check, complete tuberculosis screening and immunization review, and attend a volunteer orientation.

Please note the Regional One Health is unable to accept volunteers performing court-ordered service.

Once you complete the form, click the submit button at the bottom.

Name and Address

Demographic Information

You may optionally provide the following information. It is used only to help us get a better idea of the demographic make-up of our volunteers.


Please indicate the days and times you are usually available to volunteer.

Assignment Preferences

Please click on each assignment to learn more about duties, times needed and location. Please indicate your top three assignment choice of interest.




Please list two (2) references that recommend you for volunteer service, and that can complete our additional recommendation form. (Non-family members)

Emergency Contact

Please list someone that could be contacted in the event of an emergency.

Volunteer Interest

Additional Information

Please remember to complete all supplement documents found at step four of "Apply to Volunteer", including: background check, confidentiality, commitment to standards, and two (2) letters of reference. PDFs of documents can be downloaded from website and faxed, emailed or mailed to Volunteer Services.

Volunteer Agreement

The above information is correct and accurate to the best of my knowledge. By checking the "I agree" box, I am indicating that I approve for the above references to be checked and I will submit a reference form from each contact.

Volunteer Services is not obligated to provide a placement nor am I obligated to accept the position offered. Opportunities are provided for volunteers without regard to religion, creed, race, national origin, age or sex.

I understand that volunteer services in hospital settings are not without risk or exposure to disease, including, but not limited to, Human Immunodeficiency Virus (HIV/AIDS), Hepatitis B, and other communicable infectious diseases. However, with the proper training, which will be provided as part of the orientation process, and strict adherence by the volunteer of that training, exposure to and risk of contracting diseases can be reduced. Understanding this, I expressly assume the risks of participating in the volunteer program, and release and discharge Regional One Health, their affiliates, and their agents and employees, from any and all liabilities or claims arising from or related to the exposure to or contraction of any disease(s), ailment(s), or condition(s) as a result of participation in the volunteer program at the Regional One Health.

I acknowledge that, in the event that I become ill or am injured as a result of my participation in the volunteer program, I will not be covered by any employment-related insurance coverage such as workers compensation, although my health benefits obtained from personal sources may provide coverage. Additionally, I agree that if I am injured or become ill as a result of my participation in the volunteer program, all related costs for medical treatment or associated costs are my responsibility and are not the responsibility of Regional One Health.

I grant to Regional One Health the right and unrestricted permission to use my name, likeness, image, voice and/or appearance as such may be embodied in any photos, video recordings, audiotapes, digital images, and the like, taken or made on behalf of Regional One Health or its partners or affiliates. I agree that Regional One Health has complete ownership of such material and may use such material for any purpose consistent with its mission, including (but not limited to) promotional pieces, newsletters, videos, publications, advertisements, news releases, web sites, and any promotional or educational materials in any medium.