Please complete this application form if you are interested in becoming a volunteer at Mayo Clinic Health System in Bloomer or Chippewa Falls . Once you complete the form, click the submit button at the bottom.

Contact Information

Volunteer Availability and Experience

Please indicate what your current availability is and your past volunteer experience.

Assignment Preference

Please select the area(s) you are interested in volunteering.

Emergency Contact Information

Please provide one person as your emergency contact.

Referred By

How did you hear about Volunteer Opportunities at Mayo Clinic Health System in Bloomer or Chippewa Falls?

Confidentiality Statement

I agree to hold as absolutely confidential all information which I may obtain directly or indirectly concerning patients, doctors or staff. I agree to perform only the duties which I have been assigned or trained for. I understand that a breach in confidentiality would result in immediate release from volunteer status.

Consent for Minor to Participate in Volunteering

I authorize ________________ to participate in the student volunteer program at Mayo Clinic Health System. I certify that my son/daughter is at least fourteen years of age. I also authorize any health screening that is required by Mayo Clinic Health System for participation as a volunteer.


By typing your full name, you agree that all the information contained in this document is true and complete to the best of your knowledge. Any misrepresentation or omission of information is grounds for rejection or dismissal if selected to participate. Any and all information provided in this application may be confirmed or investigated at any time. I further acknowledge that Mayo Clinic Health System is not liable for any association thereof. I realize this is a voluntary role without compensation.