Adventist Health JR Volunteer Application

Thank you for your interest in our JR Volunteer Program. Pease complete this application and ensure you click the continue button at the bottom.

Personal Information:

First name:

Last name:

Middle name:

Nickname:

Street 1:

Street 2:

Street 3:

City:

State:

* Zip: *

Home phone:

Cell phone:

Birthday:

T-Shirt size:

Name of attending:

High school:

Graduation Year:

Email Address:

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

Email address:

Emergency Contact Information:

Please provide the name and contact number of the person whom we would contact in case of an emergency, only one is required:

1

2

First name:

Last name:

Home phone:

Cell phone:

Relationship:

Tell us about your interest in volunteering:

Please provide a brief statement of why you are interested in volunteering at AHBD to include what area in the hospital to you see yourself giving back to your community.

Choice

1st

2nd

Times

Assignment

Volunteer Commitment

I am at least 15 years of age and understand the commitment to volunteering is three hours a week on a regular basis for the session I'm applying for. A Tuberculosis Test is required prior to the start of your volunteering and due annually. The Flu Vaccine is required annually during the Flu Season. In case of injury or illness while providing volunteer services, I give permission to Adventist Health Bakersfield to administer emergency care. I agree to hold all information I may obtain concerning patients, doctors or personnel as confidential. I will also adhere to the dress code as specified by the Volunteer Services guidelines and notify the Volunteer Services Manager as soon as possible if I must terminate my volunteer service. I hereby agree to these conditions and certify that the above information is true and accurate.

I Agree