Thank you for your interest in volunteering at United Hospital. Please complete this application form if you are a middle or high school student 15 or older interested in becoming a Summer 2019 Camp United volunteer. Once you complete the form, click the continue button at the bottom.

" You will also need a parent or guardian available to approve this application on-line.

" A valid email address is a requirement to using the on-line Application process. Please make sure you type the email correctly - as it will be used as a communication tool in the application process. We do not share email addresses with any other party, internal or external.

" All items with a asterisk (*) are required fields.

" Camp United Session times are Monday - Friday, from 9 am - 4 pm each day during each session.

" You must commit to be in attendance for all 10 days of the session.

- Session choices will be mailed in April. Existing volunteers with a minimum of 24 service hours within the past 6 months will get priority session choices.

Name and address

First name:

Last name:

Middle name:

Title:

Street 1:

Street 2:

Street 3:

City:

State:

* Zip: *

Home phone:

* OK to call me here

Cell phone:

Email address:

Demographic Information

Please provide the following information. It is used only to help us get a better idea of the demographic make-up of our volunteers.

Date of birth:

Gender:

Jr High/Sr High:

Graduation Year:

Immunization Information

Evidence of immunity is a requirement for volunteering at United Hospital. When you attend a New Volunteer Orientation information will be provided on how to obtain health clearance before volunteering.

Email Preferences

A valid email address is a Camp United application requirement. We use email to communicate all Camp United information including necessary placement forms and orientation dates. Please keep the boxes below checked so you will receive this important information.

The "Application follow up" and "Volunteer Center Communication" must be checked or you will miss required information regarding next steps in the volunteer placement process. All this informatin is communicated by email.

What kinds of email would you like to receive?

Application follow-up
We ask that you leave the "Application Follow-up" box checked. We will email you with orientation date information. You need to only attend one orientation.

Schedule reminders
Convenient reminders of the dates and times you are scheduled to volunteer.

Volunteer Opportunities

Volunteer Center Communication
From time to time the Volunteer Center sends email regarding events such as: flu shots, holiday office closures, etc.

Schedule reminders

Emergency Contact Information

First name:

Last name:

Street 1:

Street 2:

Street 3:

City:

State:

Zip:

Home phone:

* OK to call here

Work phone:

* OK to call here

Parent/Guardian Consent

Thank you for taking the time to complete this application.

By checking this box, you are indicating your approval for your child's participation in the junior volunteer program. You are indicating that the information in this application is accurate and correct to the best of your knowledge.

Failure to fully and truthfully complete this application may result in denial of volunteer service or termination from the service. United Hospital Volunteer Center is not obligated to provide placement, nor are you obligated to accept the position offered. We reserve the right to place volunteers in the area we feel is best suited to their skills and the needs of the hospital.

I Agree