Please complete this application if you are interested in becoming a Taylorville Memorial Hospital volunteer. Once you complete the form, click the submit button at the bottom. Volunteers must be at least 16 years of age.


Personal Information


Demographic

You may optionally provide demographic information. Demographic information is used only to help us have a better understanding of the make-up of our volunteer team.



Volunteer Experience


Education


Employment


Emergency Contact

Please list the person to be contacted in the event of an accident or illness.



Interests and Availability

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



PLEASE REVIEW PRIOR TO PROVIDING AGREEMENT BELOW

I hereby affirm that the information on this application is true and complete. I understand that any false or misleading representations or omissions made on the application or during the orientation process may disqualify me from further consideration for a volunteer position and may result in discharge even if discovered at a later date.


I understand that Taylorville Memorial Hospital is not obligated to provide placement, nor are you obligated to accept a position, if one is offered. As a volunteer, I understand that my services are rendered on a gratuitous basis.


If completing this application as a hard copy, please sign the application as well.