Please complete this application form if you are interested in becoming a Sarah Bush Lincoln Health Center volunteer. Once you complete the form, click the submit button at the bottom. Be sure to include an emergency contact as well as two references that are not related to you.


Name and 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.



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.



Education

Please tell us where you go to school and your current major and level completed.



Emergency Contact Information

Please enter an emergency contact.



References

Please enter two references. These fields are required and your application will not be processed without this information.



Prior Experience

Have you ever volunteered in a hospital or health care setting? Is so, tell us where.



As a Volunteer:

I understand and agree that at no time will any information regarding patients of the hospital be revealed to anyone other than those authorized to receive it. I understand that the giving of the information concerning a patient to those not authorized to receive such information, is unlawful and shall be sufficient cause for immediate dismissal.


I agree to any necessary health screening required by the hospital and understand my volunteer assignment is contingent upon successful completion of this screening.


I understand that any false statements made as a part of this application may be considered sufficient cause for discontinuation of service assignment.


I authorize permission for all named references and educational institutions to release personal and professional information to the Volunteer Services department. I also consent to a police record search, if required. I further release Sarah Bush Lincoln Health Center as well as those supplying said information from any and all liability from these investigations.


I agree to observe all hospital regulations and to perform my duties in a professional manner, reflective of the organization's values, and to voluntarily offer my services with the understanding that there is no monetary compensation.