The ADULT VOLUNTEER PROGRAM is suspended at this time due to COVID-19. Your application will be put on a waitlist for placement once our program resumes.

Our Volunteer Program is very popular. While we very much appreciate your interest and willingness to serve our patients, we want you to know that we do have a wait-list for placement. Applicants applying now may NOT be placed for up to 12 months. All applicants are put on a wait-list and when we have available opportunities, we draw from that list.

Please complete this application form if you are interested in the wait list to become a Winchester Hospital Volunteer. Once you complete the form, click the submit button at the bottom.

Name and Address

First name:

Last name:

Title:

Street 1:

Street 2:

City:

State:

* Zip: *

Home phone:

Cell phone:

Email 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 volunteers.

Date of birth:

* (year optional)

Gender:

Education

What is the highest education level you have achieved (Diploma, Associates Degree, Bachelors Degree, Masters Degree)?

Education:

Previous Experience

Please list any previous volunteer experience, skills and/or special interests.

Interests

How did you become interested in volunteering?

Personal & Professional References

Please list two personal and/or professional references (excluding relatives):

1

2

First name:

Last name:

Street 1:

City:

State:

Zip:

Home phone:

Cell phone:

Email address:

Relationship:

Employee Relationship

Are any members of your family a volunteer at Winchester Hospital, or are they employees of Winchester Hospital? If yes, please list.

Connection:

Connection's Name:

Current Employment

Are you currently employed? If so, where?

Employer name:

City:

State:

Emergency Contact Information

Please list a contact name in case of an emergency. The emergency contact should be the person who is most likely to be available during your volunteer shift.

First name:

Last name:

Home phone:

Cell phone:

Relationship:

Availablity

Please indicate the days and times you are available to volunteer. We ask volunteers to commit to one shift per week for a minimum of 3 months.

Applicant Agreement

The above information is accurate and correct to the best of my knowledge. I will uphold the traditions and standards of Winchester Hospital. I will endeavor to do my best to give volunteer service of the highest quality. I will consider as confidential all information which I may hear directly or indirectly concerning a patient, doctor or any member of the Winchester Hospital personnel, and will not seek information in regard to a patient.

By choosing the "I Agree" checkbox below, you are indicating your approval for us to check references, as well as to conduct a Criminal Offense Record Investigation (CORI). Opportunities for volunteers are provided without regard to religion, creed, race, national origin, age or sex.

I Agree