Please complete this application form if you are interested in becoming a part of the Teenteer Volunteer Program with Regional One Health. Once you complete the form, click the submit button at the bottom of the or screen.


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 teen volunteers.



Email Preferences

We like to keep volunteers informed of important news, schedules, and volunteer opportunities by email, however we will not send you any emails you prefer not to receive. Use the checkboxes below to select the kinds of email you would like to receive from us.



School


References


Emergency Contact


Teenteer Essay


Additional Information

Reminder: All teen applicants must provide a copy of their high school transcripts and complete an essay.


Also, all supplemental documents required for Volunteer Services are required for teens, including: confidentiality, commitment to standards and two letters of references.



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.