Please complete this application form if you are interested in becoming a CRITTENTON HOSPITAL MEDICAL CENTER volunteer. Once you complete the form, click the CONTINUE button at the bottom. FULL NAME is required, including MIDDLE NAME! Please understand that a Background check is necessary in order to become a Volunteer at CHMC. We would appreciate it if you would fill out the form using all CAPITAL LETTERS. Thank You


Name and address


Demographic Information

Some of this information will be used to process a background check prior to becoming a volunteer at CHMC.



Maiden Name

For the Background Check, please enter in the box below your Maiden name, any last names from previous marriages,

or other names; alias's or aka's.



Availability

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



Physical Limitations

Please enter in the box below any physical limitations you may have, including but not limited to Issues with; Mobility, Lifting, Standing, or Walking.



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 Information


CHMC VOLUNTEER OPPORTUNITIES

Is your interest in GENERAL VOLUNTEER SERVICES and/or SPIRITUAL CARE SERVICES? Please enter your desire(s) in the box below.



I agree to allow CHMC to perform a Background Check on me with the information provided. I also confirm that the information provided is truthful to the best of my ability.