*Please do not complete more than one volunteer application form!*

Please complete this application form if you are interested in becoming a Church Health volunteer. Once you complete the form, click the continue button at the bottom of the page.

* indicates a required field.

Name and Address

Additional Information


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

Flu Vaccine Policy

Church Health has a strict policy regarding the influenza vaccine to protect our community, patients, and staff. All volunteers and staff are required to receive a flu vaccine which is available at Church Health. Staff and volunteers who decline vaccination must wear a mask between December 1 and March 31 when on Church Health property or working off-campus in an official Church Health function. Employees who are allergic to eggs or have a history of Guillain Barre syndrome may decline the vaccine; however, they must present a medical certification from their personal physician of their allergy or past reaction. ALL Church Health volunteers and staff, regardless of department, will be required to have a flu vaccine.

COVID-19 Risk and Waiver

Only those who are healthy, have no symptoms of coronavirus (COVID-19) or any respiratory or other illness should apply to volunteer. Those who are in high risk categories to contract Coronavirus (COVID-19) are thanked for their interest and support, but should not apply to volunteer at this time. High risk categories include:

- Individuals over 65 years of age.

- People who live in a nursing home or long-term care facility.

- Those who are pregnant or think they might be.

- People of all ages with underlying medical conditions, particularly if not well controlled, including: chronic lung disease or moderate to severe asthma, heart conditions, liver disease, obesity, chronic kidney disease undergoing dialysis.

- Those who are immunocompromised due to cancer treatment, smoking, bone marrow or organ transplantation, immune deficiencies, poorly controlled HIV or AIDS, and prolonged use of corticosteroids and other immune weakening medications.

If you are high risk or anyone in your household is high risk to contract COVID-19, you should NOT apply to volunteer at this time.

I understand and accept the risk involved in volunteering, including, but not limited to coming in contact with and potentially contracting Coronavirus (COVID-19) and I will not hold Church Health responsible for any illness or injury incurred during my time volunteering or otherwise. Further, I will minimize the risk to myself and others by wearing appropriate protective equipment and following guidelines provided by health and organization officials.

Confidentiality & Program Participation Agreements

I agree to treat both patient and/or staff records as highly confidential. I will not discuss or disclose any information which I hear, see, read or otherwise acquire except what is appropriate to discuss with center staff in a private setting. I agree that I render these health care services voluntarily, without compensation or the expectation or promise of compensation. This acknowledgement and agreement has been made before rendering any services.

I agree to report to the appropriate persons any incidents or injuries in which I am involved with during my volunteer service. I understand that my service as a volunteer is covered up to the limits specified by the center’s insurance program and I hereby waive any claim against the center except as specified herein.

I certify that the statements I have made in this application are true and accurate.