Thank you for your interest in becoming a volunteer for Ohio's Hospice of Dayton. Please complete the following application form. Fields with an asterisk (*) are required.

Contact Information

Emergency Contacts

In the event of an emergency who should we notify?


Please list two personal references. References should have personal knowledge of your qualifications to volunteer and can NOT be related to you.

Interest in Volunteering

Briefly explain your interest in volunteering with Ohio's Hospice of Dayton.

Special Skills

Please list any special skills or training you are willing to share with us.

Other Volunteer Service

Please list volunteer service to other organizations in the last five years.

Smoking Policy

Smoking is prohibited in all facilities used by and partnered with Ohio's Hospice. To eliminate residual smoke contact for our patients and customers, all staff are prohibited from smoking, on or off the campus and must not have an odor of residual smoke, while on work time. This policy applies to all colleagues, staff, students, contracted personnel, volunteers, and vendors.

Please read carefully before signing

OHI retains the right to verify all information provided by me. In the process of such verification, I fully authorize OHI to contact any person, school, organization, or employer listed to disclose all information necessary to verify information or statements. I release all persons who disclose such information from any liability or damages to me or anyone acting in my name. I waive any written notice of the release of such information that may be required by any state or federal law. Any falsification, misrepresentation, or omission, whenever discovered, shall be considered legitimate and sufficient grounds for dismissal.

As required, in order to volunteer with OHI, a 2 Step TB test will be performed. Ohio's Hospice of Dayton will conduct a criminal background check in compliance with OHI's policy for all volunteer applicants.

Volunteering with OHI is at-will. This means that I may stop volunteering at any time. Similarly, OHI may terminate my volunteering at any time, with or without cause.