Children's Specialized Hospital - Volunteer Application Form

Thank you for your interest in volunteering at Children’s Specialized Hospital.

Please complete the application below. Once your application is received, we will contact you with further information regarding our volunteer process.

We appreciate your interest and desire to dedicate your time to our hospital.

Stay healthy and safe!

Best Regards,

Volunteer Department

Personal Information

First name:

Last name:

Middle name:

Title:

Preferred name:

Street 1:

Apt. #:

City:

State:

* Zip: *

Primary phone:

Additional phone:

Cell phone:

Email address:

Birthday:

Name and Phone Number for Emergency Contact

First name:

Last name:

Primary Contact phone:

Relationship:

Education Level or School Currently Attending

Education:

School:

Current Employer:

Type of Volunteer Position Preferred

Volunteer Experience

What type of volunteering have you done in the past? And, for how long have you volunteered?

Previous Volunteer Experience

Reason for Volunteering

Volunteer Commitment

Can you commit to serving 2-3 hours a week for a minimum of 30 hours per year?

30 Hours per Year Required:

Desired Facility/Location

Please choose your preferred facility/location.

Required Number of Hours

If you are required to complete a specific number of hours, please fill in the box below.

Required Hours:

Days and Hours Available

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

Parent Consent Signature IS REQUIRED if Under 18

First name:

Last name:

Primary Contact phone:

I Agree

In accordance with Children’s Specialized Hospital Policy I confirm that I Am 15 years of age or older. If accepted as a Volunteer at Children’s Specialized Hospital, I promise to abide by all the rules and regulations of the hospital and its departments. Failure to comply with hospital policy and confidentiality is understood to be grounds of separation from Volunteer Department.

Volunteer Signature: