Please complete this application form if you are interested in becoming a Desert Regional Medical Center volunteer in either our Adult or Teen summer programs. Once you complete the form, click the submit button at the bottom.


Name and Address


Demographic Information

Please provide your Social Security Number in the open box below. Our system for both transmitting and storing this information is encrypted and secure.



Availability

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



Previous Volunteer Service

Please tell us about any previous volunteer service.



Emergency Contacts


Personal and Professional References


Please Read Carefully!

I understand that I am volunteering at Desert Regional Medical Center and the information provided is true and correct and has been given voluntarily. As part of the agreement, I will be able to work at least (4) hours per week for a period of (6) months or more.


I agree to hold absolutely confidential all information which I may obtain directly or indirectly concerning patients, doctors, or personnel, and not seek confidential information in regard to a patient.


I will make the commitment to:

• Be punctual and conscientious

• Willingly follow the instruction of my supervisor

• Be responsible for fulfilling my commitment to the hospital

• Conduct myself with dignity, courtesy, and consideration of others

• Take any problems, criticisms, or suggestions to the Director of Volunteer Services if unable to resolve with my supervisor

• Endeavor to make my work professional in quality

• Uphold the philosophy and standards of the hospital and interpret them to the community at large


The volunteer Services Department reserves the right to terminate a volunteer for:

• Failure to comply with hospital policies, rules, and regulations

• Continuous absences without prior notification

• Unsatisfactory attitude, work, or appearance

• Breach of confidentiality

• Falsification of time records


My services are donated to Desert Regional Medical Center without contemplation of compensation or future employment and given with humanitarian, religious or charitable reasons. I will not hold DRMC responsible for any claim or damage as a result of injury, illness or other harmful effects or conditions that may arise related to the volunteer services performed. I authorize DRMC permission to give emergency medical treatment to me if ever needed.