Thank you for your interest in becoming a member of Partners of Crossing Rivers Health. Please complete this form. Then click "Continue" at the bottom.

Once your application has been accepted, a member of our team will contact you regarding your level and areas of interest.

Contact Information

First name:

Last name:

Title:

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:

OK to call me here

Email address:

Demographic Information

Everyone should complete this section.

Date of birth:

Please check level of interest:

If you wish to be a Contributing Member only, this is the last section of this application you will need to complete. You may then skip to the "I Agree" section at the bottom.

Level of Interest:

Active Member

Community Member

Contributing Member (Partners only)

Community Events and Projects

If you wish to volunteer from home or one time intermittent projects, this is the last section of this application you will need to complete. Please check any fundraisers, projects and events you are interested in. You may then skip to the "I Agree" section at the bottom.

Active Volunteers

If you wish to volunteer IN our facility, please complete the remainder of this application.

Assignmennt Preference

Assignment Preference:

1st choice:

2nd choice:

3rd choice:

4th choice:

5th choice:

6th choice:

7th choice:

8th choice:

Availability

In general, volunteers work a 4-hour shift. Please indicate the days and times you are usually able 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.

What kinds of email would you like to receive?

I Agree

I authorize full and complete investigation of my application information. This process may include interviewing professional and personal references, criminal history verification, and other relevant processes. I understand that any misrepresentation or falsification of this application may constitute rejection or dismissal.

In addition, I do hereby agree to indemnify and hold harmless Crossing Rivers Health, its employees, volunteers or agents from any and all claims or causes of action that may arise out of performance of my assigned duties as a volunteer. I waive any right I have against Crossing Rivers Health in consideration of my participation as a volunteer for the programs and offices of Crossing Rivers Health. In closing, I agree that my volunteer services are donated to Crossing Rivers Health without contemplation of compensation or promise of future employment.

I Agree