Please complete this application form if you are interested in becoming a Hancock Regional Hospital volunteer. Once you complete the form, click the submit button at the bottom.

Name and address


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

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.

Emergency Contact

In the case of an emergency, contact:

Refrence Section

List three references,who are not relatives, prefer employer, former employer, minister, etc.


I hereby certify that all information contained in this application is true and correct to the best of my knowledge.
I authorize the investigation of all statements contained in this application as may be necessary in arriving at a volunteer assignment decision, including reference checks and a criminal history background check.
I understand that, in the event of being accepted as volunteer, false and misleading information given through my application or interview(s) may result in discharge.