Volunteer Application Form

Please complete this application form if you are interested in becoming a Healthcare Network volunteer. Once you complete the form, click the Continue button at the bottom.


Name and address


Demographic Information


How did you hear about this volunteer opportunity?


Languages


Availability

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



Email Preferences

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



Emergency Contact


Criminal history


The information in this application is true and complete. As a volunteer with Healthcare Network, I agree to follow all Healthcare Network guidelines and policies. I understand that all patient information is confidential by law. Volunteers are prohibited from discussing patient information with persons other than those directly involved in the patient’s care. As permissible, all conversations should be held in the utmost private manner, away from others who could overhear information. Breach of confidentiality carries with it the possibility for disciplinary action, legal and financial penalties.

I agree to the use of my personal information for the purpose of activities related to the volunteer program (such as communication on activities, tracking of hours worked, recognition, updates on Healthcare Network services and programs).