Please complete this application form if you are interested in becoming a Columbus Regional Health volunteer. Once you complete the form, click the submit button at the bottom.


Name and address


Emergency Contact


Demographic Information

You may optionally provide the following information. It is used only to help us get a better idea of the demographic make-up of our volunteers. Volunteer Services does not discriminate on the basis of age, sex, race or color, national origin, religion, or disability.



Reason to Volunteer


Availability

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



Email Preferences

We like to keep volunteers informed of important news, schedules, and volunteer opportunities by email, however will not send you any email you prefer not to receive. Use the checkboxes below to select the kinds of email you would like to receive from us.



Columbus Regional Hospital Volunteer Services requires a criminal background check and reference check(s) on all volunteers. Direct patient care areas of volunteer service require a drug screening also.


I certify that all information on this application is correct and true, and I understand that any misrepresentation or willful omission of material facts will be sufficient reason for rejection of my application or, if volunteering, my immediate discharge.