Thank you for your interest in volunteering at UCHealth Highlands Ranch Hospital with your therapy animal. (Please note that only dogs and miniature horses are eligible for this program.) Therapy animals and their handlers play an important and meaningful role in providing extraordinary care to our patients and their families. Please complete this application form in its entirety if you are interested in applying to be a Pet Therapy Volunteer Team at UCHealth Highlands Ranch Hospital. (Please note that all Pet Therapy Team Handlers must be at least 21 years of age.) Once complete, click the SUBMIT button at the bottom of the form.


Following submission of this form, you will be contacted to schedule an interview with the UCHealth Highlands Ranch Hospitality Services Manager, Melissa Strickland or a member of the Pet Therapy Leadership Team.


If you are accepted into the program, you will be required to submit the following:

1) Proof of current membership in an organization that provides national certification including, but not limited to:

  • Therapy Dogs International
  • Pet Partners
  • Alliance of Therapy Dogs (ATD)
  • Go Team

2) Proof of current rabies vaccination.

3) Current Health Certificate including a list of vaccinations from your veterinarian.

4) Complete 1-2 shadow visits with an experienced Pet Therapy Team.


We look forward to meeting you! If you have any questions, please call Melissa Strickland at 720.516.0186


Handler Information

Please provide the following information about you as Handler for your pet:



About Your Pet


Why UCHealth Highlands Ranch?

Tell us why you would like to volunteer at UCHealth Highlands Ranch Hospital with your pet. Please include any previous pet therapy experience you have had.



Tell us about your previous volunteer experience:

What challenges did you meet and how did you make a difference for others?



Availability

Please indicate the days and times you and your pet would be 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.



Disclosure

Have you ever been convicted of a misdemeanor or felony?



Disclosure Explanation

If you answered 'yes' to a misdemeanor or felony charge/conviction, please explain: (required)



Emergency Contact Information

In the event of an emergency, whom should we notify? Please list only those that can make decisions for you legally, and select a relationship from the 'Relationship' dropdown menu.



Reference Form Requirements

Volunteer applications require two (2) references. Once you have submitted your application, you will receive an email with a link to the reference form. Please send that to two individuals for completion. All references must be returned in order to complete the application process.



UCHealth COVID-19 Acknowledgement

Under CDC guidelines, UCHealth has established the following COVID-19 protocols. We are grateful to all our volunteers for the tremendous service provided to the hospital, staff and guests. We want volunteers to be able to return to service in a safe environment. Each volunteer will review and agree to the safety requirements and expectations of volunteering. 

1. I will wear a mask when entering and while in the hospital or any of our facilities until such time that it is determined by Infection Prevention that we no longer have to wear masks. I understand that UCHealth will provide a surgical mask for me to wear during my volunteer experience. I understand that I cannot remove or touch my mask during my shift. 

2. I will make myself aware of and follow UCH's social distancing guidelines in effect while volunteering and while traveling through the hospital. I will respectfully assist others in doing the same. 

3. I will follow hand hygiene by washing my hands and using hand sanitizer as required. I will disinfect my workspace and frequently touched surfaces. I will use the UCHealth provided disinfection materials and gloves will be made available for sanitizing. 

4. I will follow expectations about keeping attire clean, including laundering my volunteer vest.

5. I am aware of the CDC COVID-19 guidance for individuals who may be at risk due to age or pre-existing conditions and know I may make my own choices. I also understand the possible risk of exposure in returning to service. 

6. I understand that I may not enter units caring for COVID patients and I may not enter a room with a COVID patient. I will continue to abide by all HIPAA and confidentiality laws pertaining to the privacy of patient information. This includes information pertaining to any COVID patients. 

7. I will stay at home and notify the Hospitality Services Manager if I have any COVID or flu-like symptoms; including but not limited to cough, shortness of breath or difficulty breathing, fever, chills, headache, sore throat, loss of taste or smell. I will contact my personal provider and follow their guidance. 

8. I understand that the situation is dynamic and the COVID-19 safety protocols may change over time. It is my responsibility to follow the protocols as they change. By volunteering, I acknowledge that I agree to and will follow COVID-19 related protocols and all hospital policies.

As a condition of my returning to service while under COVID 19 protocols. If at any time I decide I do not want to comply with the COVID-19 safety protocols or other hospital policy, I will discuss when and how I can return to serving as a UCHealth volunteer.



Disclaimer

All applicants must sign in the Applicant Signature box at the bottom of this form.

Submitting an application through the website constitutes your electronic signature. Any record containing an electronic signature shall be deemed for all purposes to have been 'signed', and will constitute an 'original' when printed from electronic records established and maintained by UCHealth Highlands Ranch Hospital in the normal course of business. Upon UCHealth Highlands Ranch Hospital's request, user agrees to sign or place User's signature on any paper original of any electronic record that UCHealth Highlands Ranch Hospital provides to user containing user's purported electronic signature.


I understand and agree that submitting this application form does not automatically register me as a UCHealth Highlands Ranch Hospital Volunteer, and that there may be certain qualifications I must meet, including the acceptance of established volunteer policies and procedures before I may begin volunteering.

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

NOTE: UCHEALTH HIGHLANDS RANCH HOSPITAL NO LONGER PARTICIPATES AS A COMMUNITY SERVICE PROVIDER. NO COURT-ORDERED 'COMMUNITY SERVICE' WILL BE ACCEPTED OR VALIDATED.

All adult applicants being considered for volunteering are required to complete an Authorization and Release for a Criminal Background Investigation and a Drug Screening.

If you have been convicted of a Misdemeanor or Felony, you are required to disclose this to the Volunteer Services Office with an explanation of charges.

I certify the facts documented on this application are true and correct without consequential omission. I understand that an offer of volunteer work may be rescinded either before or after my date of assignment pending results received from my background investigation and/or drug screening.

I understand any volunteer assignment with UCHealth Highlands Ranch Hospital is voluntarily entered into and does not constitute a contract of employment, expressed or implied. Further, I understand that my volunteer placement could be terminated at any time based on the discretion of the Volunteer Services Manager.

PHOTO CONSENT: This is to certify that I give permission to UCHealth to use my image for news media, marketing, public relations, and/or hospital business purposes. Please type your name in the field below as a form of electronic signature.



Click the 'I Agree' box below indicating that you agree with the Disclaimer above. Then click the Submit button to submit your application for consideration.