Please complete this application form if you are interested in becoming a Hospice of Mercy Volunteer. Once you complete the form, click the Continue button at the bottom.

Contact Information

Please complete the following information regarding your general contact information. If you do not have an email address, please use

Emergency Contacts

We are committed to your safety. This is why we require two Emergency Contacts in the event we are unable to reach your first. Please complete the following information.

Demographics & Personal

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.

How did you hear about us?


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

Assignment Preference

Criminal History

Have you ever been convicted of, or plead guilty to a criminal offense (misdemeanor or felony)? Mercy conducts criminal checks. Falsification of this or any other information on the application is grounds for immediate termination. A conviction does not necessarily disqualify you from volunteering. Acceptance into Mercy's volunteer program will be made on a case by case basis.

Anything Else?

I Agree

I understand and agree that submitting this application form does not automatically register me as a Hospice of Mercy Volunteer, and that there may be certain qualifications I must meet, including the acceptance of established volunteer policies and procedures before I may begin volunteering.

I have not had the death of someone close within my immediate family over the past year. If I have, I will communicate it with the Hospice Volunteer Coordinator at

By submitting this form, I attest that the information I have provided on the form is true and accurate. I understand and agree that falsification of this or any other information is grounds for immediate termination.