This application is for ADULT VOLUNTEERS (age 18+).

Please complete this application form if you are interested in becoming a HonorHealth volunteer and able to commit to serve at least one 4-hour shift each week for 6-months or more. Once you complete the form, click the submit button at the bottom.

Please note: HonorHealth requires volunteers to be vaccinated against COVID19 and to receive the upcoming flu shot vaccination (some exceptions made for medical or religious reasons). Please consider your ability to receive both vaccinations when applying for service.

We are looking forward to getting to know you and learning more about your interest in serving the community and the patients and families of HonorHealth.

Name and Address

First name:

Last name:

Title:

Street 1:

Street 2:

Street 3:

City:

State:

* Zip: *

Home phone:

* OK to call me here

Work phone:

OK to call me here

Cell phone:

OK to call me here

Email address:

Birthday:

Pet Therapy Team:

Emergency Contact

In the event of an emergency whom should we notify?

First name:

Last name:

Home phone:

OK to call here

Work phone:

OK to call here

Cell phone:

* OK to call here

Email address:

Relationship:

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.

Skills and Experience

In which of these areas do you feel you have moderate to excellent skill? Check all that apply.

Availability

Please indicate which medical center campus you prefer and the days and times you are usually available to volunteer. Your volunteer service will be on a consistent schedule each week (example: Tuesdays from Noon - 4pm).

Additional Information

Please describe any additional information you would like us know regarding your interest in volunteering with HonorHealth.

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.

What kinds of email would you like to receive?

Volunteer & HonorHealth News

Messages from Volunteer Office

Help Wanted to Cover a Shift

HonorHealth Foundation News

Checklist reminders

I Agree

By submitting this form, I attest that the information I have provided on the form is true and accurate. I understand and agree that submitting this application form does not automatically register me as a HonorHealth volunteer, and that there may be certain qualifications I must meet, including passing a background check and the acceptance of established volunteer policies and procedures before I may begin volunteering.

I agree that HonorHealth may use email to communicate with me regarding my volunteer service. I understand that email is not a secure medium for sending and receiving potentially sensitive personal healthcare information. HonorHealth cannot assure the confidentiality or protection of email communications, particularly if the emails are sent to multiple individuals participating in volunteer services. In addition, email sent to HonorHealth may be accessed by individuals who are not directly involved in Volunteer Services (for example: by my employer if my email address is provided, by my internet service provider). Volunteer information is being stored on a third-party system, Volgistics, and I accept Volgistics terms and conditions.

I Agree