Adult volunteers must be at least 18 years old and not in high school or college.

Please complete this application form if you are interested in becoming a volunteer with Memorial Health. Once you complete the form, click the submit button at the bottom.


Personal Information


Emergency Contact

In the event of an emergency whom should we notify?



Volunteer History

Have you ever volunteered for or been employed by Memorial Health? If yes, when?



Volunteer Interest

How did you become interested in our volunteer program? What do you hope to gain from your volunteer experience?



Assignment Preference

The following volunteer assignments may currently be available. You may click the assignment names to learn more about that assignment. Use this list to let us know for which assignments you may like to volunteer.



Availability

Please indicate the days and times you are usually available to volunteer.



Employment Information


Educational Information


Message Preferences

We like to keep volunteers informed of important news, schedules, and volunteer opportunities by email, however we will not send you any email you prefer not to receive.



Background Check

We consider the safety and security of our patients to be of the utmost importance. We will conduct, at our cost, a criminal background check with state and federal agencies.



Confidentiality Statement

I will consider as confidential all information that I may gain in my volunteer position, directly or indirectly, concerning patients, doctors, staff, employees, families, and volunteers. I understand that my volunteer services will be terminated as a result of any breach of confidentiality.

The above information is accurate and correct to the best of my knowledge, and has been given voluntarily. I understand that this information may be disclosed to any party with legal and proper interest, and I release the agency from any liability whatsoever for supplying such information.

I understand that I will not be paid for my services as a volunteer.

I will receive the Memorial's volunteer handbook through the onboarding process, and I will agree to abide by the volunteer policies of Memorial Health once completed, unless otherwise noted.



I Agree

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