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


Email

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



Demographic Information


Availability

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

Receptionist

Gift Shop

Information Desk

Library Cart

Community Garden




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.