Adult Volunteer Application Form
Please complete this application form if you are over the age of 17 and are interested in becoming a Lake Region Healthcare Adult Volunteer. Once you complete the form, click the submit button at the bottom.

Name and address

Telephone Number

Cell Phone Number


We like to keep volunteers informed of important news, schedules, and volunteer opportunities by email.

Demographic Information


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

Previous Work Experience

Please explain your previous work experience

Hobbies, Skills & Special Interests

Please explain your hobbies, skills and special interests

Please list the areas you are interested in

Cancer Center Greeter/Snack Bar
Gift Shop Clerk
Courier Driver
Community Garden
Rock Steady Boxing
Patient and Family Advisory Council
Mill Street

Any activities or conditions you must avoid?

Explain if there are any work activities or conditions you must avoid.

Emergency Contact

Please fill in the requested information for one person to be contacted in the case of illness or injury.

Personal Reference

Please fill in the requested information for one person whom we may contact for a personal reference.