Junior Volunteer Program Application

If you are interested in becoming a Yuma Regional Medical Center volunteer and you are 16-18 years old and still in high school, please complete the JR Volunteer application form. Once you complete the form, click the "continue" button to submit at the bottom.

Name and Address

Please enter your name and complete physical address. You may enter a mailing address at the bottom of this section.

Mailing Address

Please include if mailing address is different than home address.

Demographic Information

The following questions are asked to give us a better understanding of the demographic makeup of our volunteers.

Volunteering at YRMC

Previous Volunteer Experience

Please indicate any past volunteer experience including location, how long you volunteered, duties, and responsibilities.


Please check all the available days and times to help us find the best placement for you.
Usual Shift Times: Morning: 7 or 8-12 or 1: Afternoon: 12 or 1-5; Evening: 5-8

Emergency Contact

In Case of Emergency, please list a parent or guardian:


Please list two people (who are adults and not related to you) who know you well and can answer questions regarding your character and abilities. We will check one (1) of these references by phone or email.

Criminal Offenses

A conviction does not automatically mean you cannot be accepted. What you were convicted of, how old the conviction is, and what the nature of the positions for which you are applying are important. Please give us all the facts.

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.


By Checking "I Agree" and submitting my application, I am stating that, to the best of my knowledge, the information I have provided is true and correct. I agree to:

CONFLICT OF INTEREST: It is important to the integrity and success of YRMC that all volunteers strive to avoid any actual, potential, or implied conflict between their interests and the interests of YRMC. Volunteers may have access to privileged, confidential information regarding YRMC business or professional activities and they must not use such information to derive personal benefit, either directly or indirectly, whether it is financial or otherwise.

CONFIDENTIAL INFORMATION: As a YRMC volunteer you may have access to privileged information concerning patients or employees. When you accept an assignment, you also accept an obligation to keep confidential information precisely that--confidential. Only physicians, under certain circumstances, are authorized to release medical, surgical, or laboratory findings regarding a patient or his/her diagnose. Volunteers may not reveal any of this information. Carelessness or thoughtlessness in the handling of such information is ethically unacceptable and could expose you and YRMC to legal action. You must also understand that in the performance of your duties as a volunteer, you must hold in strict confidence any observations you may make, see, or hear regarding patients, physicians, or personnel.

I understand and agree that submitting this application form does not automatically register me as a YRMC 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.

I have read the above statement, I understand the contents and I agree to conduct myself in accordance with this requirement. I will not discuss confidential information regarding patients, employees or business operations. Our volunteer positions should not be viewed as a means of obtaining permanent employment at YRMC. Persons seeking paid positions should apply online with Human Resources Department.

CONDITIONS: If accepted, I agree to abide by all policies and guidelines of the Volunteer Services Department. I understand that my volunteer service is at will, meaning that it may be terminated at any time by either party. I authorize and consent to a background screening report and health screening.

By submitting your application, you are affirming that all information you have provided in this application is true and complete and that any misrepresentation, falsification, or willful omission herein shall be sufficient reason for dismissal and/or refusal of employment.

STATEMENT OF UNDERSTANDING: Yuma Regional Medical Center makes a large investment in each person who comes into our facility to volunteer. Therefore, it is important that each volunteer applicant understand and agree to the items listed below. Volunteer placement is contingent on acceptance into the program following successful completion of the interview and screening process. Please read each and check the box at the bottom to confirm agreement and understanding: