Please complete this application form if you are interested in becoming a volunteer at Banner Wyoming Medical Center . Once you complete the form, click the Continue button at the bottom.

Certified Dog Therapy Requirements:

We are currently on-boarding certified Dog Therapy teams who can provide great customer service to Banner Wyoming Medical Center's patients, guests, and staff at all times, and can comply with the following requests:

* Dog Therapy Requirements:

Commit to up to 2 hours shifts/week

Dog at least 1 year or older

Provide Dog Therapy Certification

Provide proof of Rabies & Fecal Exams

Dog's Information:

Please provide the following information for your dog.

Legal First name:

Legal Last name:

Street 1:

City:

State:

* Zip: *

Date of birth:

Gender:

Dog Handler's Requirements:

*Please Note - Banner Health requires COVID-19 vaccines for all employees and volunteers. Ensure you are fully vaccinated before applying.

The dog handler(s) for the team will need to complete Banner Health's Volunteer Application(s) and the on-boarding process including: all required documents, a TB screening and annual flu vaccination during flu season, a background check along with orientation and training.

Dog Handler's Contact Information:

Please provide Dog Handler's Information. If there will be more than 1 handler for dog, information is required for both. Each handler will also need to complete their own application and on-boarding process.

1

2

First name:

Last name:

Street 1:

Street 2:

City:

State:

Zip:

Primary Phone phone:

Email address:

COMMITMENT TO CONFIDENTIALITY AND SERVICES

By checking "I Agree" and submitting my application, I am stating that to the best of my knowledge all information I have provided is true and accurate.

I agree to:

1. Hold as absolutely confidential all information which I may obtain directly or indirectly concerning patients, doctors/nurses, personnel/staff, and I will not seek confidential information in regards to a patient.

2. Uphold Banner's Mission, Values, and Purpose Standards.

3. Endeavor to make my duties as a volunteer the highest quality.

I understand that my services are donated to Banner Health System without contemplation, or future employment and given for humanitarian or charitable reasons. I verify that the preceding information on this application is true and accurate. I also understand that there are many types of volunteer opportunities with Banner Health System facilities, and that I will be required to complete all requirements including: Volunteer Health screening, required TB screening at Banner Occupational Health, an annual flu vaccination, Background Check, Volunteer Orientation and training, and annual education.

I Agree