Please complete this application if you are interested in becoming a Littleton Adventist Hospital Junior Volunteer. Once you complete the form, click the Submit button at the bottom of the form.


Volunteer Information


EMail


Areas of Interest

Check one or more areas of interest.



Skills & Experience

Check the skills below that you either enjoy or have experience in. Check all that apply.



Availability

Please indicate the days and times you are usually available to volunteer (4-hour shifts).



Emergency Contact

In the event of an emergency whom should we notify?



I Agree

I understand and agree that submitting this application form does not automatically register me in the Littleton Adventist Hospital Junior Volunteer Program, and that there will be certain qualifications I must meet, including the acceptance of established volunteer policies and procedures before I may begin volunteering.


A TB Test is required of all volunteers. If you have had a TB test within the current calendar year, you must provide verification at time of interview. If this document is not available, the hospital lab will do a FREE blood draw. If you are not immune, you may obtain a vaccination from your Primary Care Physician.


An annual Flu Shot is required of all volunteers who work during the fall or spring semester and no exceptions can be granted. However, flu shots are not required for those working only during the summer session. Volunteers can receive a FREE flu shot at the hospital lab or provide verification from another medical facility.


By submitting this form, I indicate my commitment to the Junior Volunteer Program for a minimum of 7 weeks during the Summer Program OR for the agreed upon shift during the school year. I will attend the Orientation. I confirm that I will honor the confidentiality of all patients. At no time will I mention or discuss patients in the hospital or away from the hospital. I also confirm my understanding that I am not covered by the hospital's workman's compensation policy, and if I am injured, my personal health insurance will be solely responsible.

By submitting this form, I attest that the information I have provided on the form is true and accurate.