Adult Volunteer Application

Thank you for your interest in volunteering with East Tennessee Children's Hospital. Please complete this application form and submit.

Eligible volunteers must be 18 years of age and older and no longer in high school.

Please Note:

-All volunteers are required to receive a flu vaccination when volunteering during the months of November through April.

-All volunteers are required to commit to a weekly four-hour shift for at least six months.

-All volunteers are required to submit MMR vaccination records.

Once you complete the form, click "Continue" at the bottom.

Personal Information

First name:

Last name:

Middle name:

Title:

Nickname:

Street 1:

Street 2:

Street 3:

City:

State:

* Zip: *

Home phone:

OK to call me here

Work phone:

OK to call me here

Cell phone:

Email address:

Date of birth:

Ok to share contact info within ETCH?:

College Student:

Employer name:

Work phone:

If you are in college, please enter your school name and current major.

Medical

Please list your physician and check if you are not willing to have a flu shot. (Children's Hospital Volunteers are required to have a flu vaccine when volunteering during the months of November through April.)

Physician's Name:

Physician's Phone:

Will not have a flu shot:

Emergency Contacts

Please list two emergency contacts.

1

2

First name:

Last name:

Home phone:

Cell phone:

Relationship:

Availability

Please check the days and specific shifts you are currently available for a volunteer assignment.Typical shifts: Morning: 8:30 am - 12:30 pm, Afternoon: 12:30 - 4:30 pm, Evening:4:30 - 8:30 pm (You will be expected to volunteer weekly for 6 months and we will work with you if your schedule should change.)

Children's Hospital Relationships

Please list any family or friends who either work or volunteer at the hospital.

1

2

First name:

Last name:

Relationship:

Volunteer Interests

* Activity Interests:

Why would you like to volunteer for Children's Hospital? Are there any specific interests you wish to pursue as a volunteer?

Work Experience / Skills

Please list any applicable education or work experience. Also please list any additional skills (i.e. foreign language, musical or artistic).

Volunteer Experience

Please list any volunteer experience: (Organization & Dates) What did you find to be most enjoyable about these experiences?

References

List the names of two people, other than relatives, who have known you for at least one year and would be willing to serve as personal references. Please include an email address for each person.

1

2

Employer name:

First name:

Last name:

Home phone:

Work phone:

Cell phone:

Email address:

Background Reference

A background check will be performed before acceptance into this volunteer program.

Have you ever been convicted of a felony or misdemeanor?

Select Yes or No:

If yes, please list the offense, date, location, disposition and explanation.

Permission to Verify Content

I hereby authorize verification of all statements herein and release Children's Hospital and all others from liability in connection with same.

I Agree