Please complete this application form if you are interested in becoming a St. Dominic Hospital volunteer. Once you complete the form, click the submit button at the bottom. (Please note that family members will not qualify as a Personal Reference.)

Name and address

Demographic Information

Email Address

Present Occupation

Criminal Convictions

Prior volunteer experience

How did you hear about us?

Person to call in the event of an emergency

Days and Hours preferred

Personal Physician

References (name, address, phone number)


I agree that the above information is accurate to the best of my knowledge.