Fernside Volunteer Application Form

Please complete this application form if you are interested in becoming a Fernside volunteer. Once you complete the form, click the Continue button at the bottom.

Name and Address

First name:

Last name:

Street 1:

Street 2:

City:

State:

* Zip: *

Primary phone:

Email address:

Emergency Contact

First name:

Last name:

Primary phone:

Relationship:

Demographics

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:

Gender Identify:

Education:

Race:

T-Shirt size:

Ethnicity:

Major degree:

School:

Employer:

What is your Primary Language?:

Areas of Interest

Please indicate below various areas you are interested in:

Areas of Interest:

Skills & Talents

Please let us know about special skills and talents you can share with Fernside:

How did you hear about Fernside?

How did you hear about Fernside?:

Previous Volunteer Experience

Why do you want to volunteer at Fernside?

Bereavement History

If you have experienced the death of a family member or close friend, please share about that experience and what has helped you during your grief process.

Criminal History

All applicants are required to have a fingerprint criminal background check at TriHealth prior to volunteering. This is provided at no charge. Have you ever been convicted of a crime? If you answer "Yes" please share details below:

Agreements

Fernside respects the right of privacy belonging to all those individuals participating in our support groups. We assure our families that any information they share in group is confidential and will not be repeated outside of Fernside.

Volunteers should never use their personal phones or cameras to record video, audio or still pictures of Fernside group members. Volunteers should never post group pictures or content information on their social media accounts.

I understand that a COVID vaccination is required and a copy of my card will be kept on file.

I Agree