Completing the teen application form below is only step 1 in the process of becoming a St. Anthony Medical Campus volunteer. Once you complete this form, click the submit button at the bottom. After you submit the application, the confirmation screen and email will provide a link you MUST use to register for an information session; this is step 2 of the process. YOU MUST COMPLETE BOTH STEPS IN ORDER TO BE CONSIDERED AN APPLICANT.

Name and address

First name:

Last name:

Title:

Street:

City:

State:

* Zip: *

Home phone:

* OK to call me here

Work phone:

OK to call me here

Email address:

Shirt Size:

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:

Availability

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

Sun

Mon

Tue

Wed

Thu

Fri

Sat

From:

To:

Emergency Contact

In the event of an emergency whom should we notify?

First name:

Last name:

Street 1:

Street 2:

City:

State:

Zip:

Home phone:

Work phone:

Cell phone:

Email address:

Relationship:

How did you hear about this opportunity?

School:

Please indicate from the following: -St. Anthony Medical Campus website -Centura Health employee -Volunteermatch.org -Senior Blue Book -Friend -Other (please explain)

Why are you interested in volunteering?

I Agree

I understand and agree that submitting this application form does not automatically register me as a St. Anthony Medical Campus 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.

By submitting this form, I attest that the information I have provided on the form is true and accurate.

I Agree