Volunteer Application Form
Please complete this application form if you are interested in becoming a Door County Medical Center Auxiliary volunteer. Once you complete the form, click the Continue button at the bottom.
Name, Address
Fields with * are required
First name:
*
Last name:
*
Street address:
*
Apt. #:
City:
*
State:
Choose
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
*
Zip:
*
Home phone:
*
OK to call me here
Work phone:
OK to call me here
Cell phone:
OK to call me here
Email address:
*
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.
Date of birth:
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
1
2
3
4
5
6
7
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11
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13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
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1967
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1965
1964
1963
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1961
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1955
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1952
1951
1950
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1948
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1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
1919
1918
1917
(year optional)
Gender:
Choose
Female
Male
Availability
Please indicate the days and times you are usually available to volunteer.
Mon
Tue
Wed
Thu
Fri
Morning:
Afternoon:
Membership Preference
- Active members of the Auxiliary participate in volunteering in the hospital and fund raising activities.
Dues: $25.00 (annual fee)
- Supporting members of the Auxiliary will participate in volunteering outside the hospital and fund raising activities.
Dues: $25.00 (annual fee)
- Life members of the Auxiliary participate in volunteering and fund raising activities.
Individual Dues: $150.00 (one-time fee)
Couples Dues: $225.00 (one-time fee)
Type:
Choose
Active
Active - Life
Supporting
Supporting - Life
*
Skills and Interests
Please indicate any areas of skills or interests. Use the check boxes below to select as many of the areas that apply.
Skills/Interests:
Advertising
Communications
Community Events
Finance
Food Preparation/Baking
Fundraising
Healthcare
InformationTechnology
Leadership/Management
Marketing/Sales
Public Relations
Retail
Senior Care
Assignment Preference
In what areas are you interested in volunteering?
Assignment Preference:
Ambassador Guide [Volunteer Services]
Angel Ball [Events]
Baking [Volunteer Services]
Cancer Center [Volunteer Services]
Crocheting, Knitting, Sewing etc [Volunteer Services]
Dental Clinic [Volunteer Services]
First Grade Tours [Events]
Fundraising Committee [Committees]
Gift Shop [Volunteer Services]
Historian [Volunteer Services]
House and Garden Walk [Events]
Marketing Committee [Committees]
Newsletter & Editing [Volunteer Services]
OPSU (Outpatient Surgical Unit)- General [Volunteer Services]
Orthopedic Joint Care Class [Volunteer Services]
Pet Therapy [Volunteer Services]
Plant Care [Volunteer Services]
Scholarship Committee [Committees]
Skilled Nursing Facility: Activities [Volunteer Services]
Skilled Nursing Facility: Beauty Shop [Volunteer Services]
Skilled Nursing Facility: General [Volunteer Services]
Skilled Nursing Facility: Greeting Desk [Volunteer Services]
Sunshine Committee [Committees]
Temporary Task [Volunteer Services]
I Agree
I understand and agree that submitting this application form does not automatically register me as a Door County Medical Center Auxiliary volunteer, and that there will be certain qualifications I must meet, including the acceptance of established volunteer policies and procedures before I may begin volunteering. All applicants will be asked to complete and submit a Hospital Auxiliary Background Information Disclosure form. Additionally, Active and Active-Life applicants will be asked to participate in a Medical Clearance process (at no cost to the applicant) prior to volunteering in the Hospital. Member dues will be collected at the time of orientation.
I Agree
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