Become a Lima Memorial Volunteen

Volunteen Application

Please complete the fields below.

First Name *

Last Name *

Age *

Date of Birth *

Street Address *

City *

State *

Zip Code

Email Address *

Phone Number *

Cell Phone Number *

Parent's Name(s) *

Emergency Contact First and Last Name *

Emergency Contact Relationship *

Emergency Contact Preferred Phone Number *

Emergency Contact Email Address *

High School Name *

Do you consent to us contacting your school Guidance Counselor for a reference?

Yes
No

Please check any area(s) where you may be interested in volunteering: *

Patient & Visitor Escort
Gift Shop
Nursing Unit Assistant
Supply Stocking & Running
Information Desk Greeter
Cafeteria Worker
Clerical
Facilities Management
Other

Date you are available to start: *

Are you a part of any extracurricular activities that might interfere with your ability to fulfill your schedule (i.e. Sports, band, camp, family vacation? (Please note that answering yes does not disqualify you from volunteering) *

Are you interested in continuing to volunteer once the new school year starts, even if it is a different day / time or in a different area than what you work this summer? *

Please tell us why you want to volunteer: *

Career Interests:

What types of things interest you?? What hobbies do you have?

Do you have a parent who is, or has ever been employed by LMHS?

Do you have any friends or relatives who currently volunteer for LMHS?

Date *

Captcha

Form Submission

Please wait for the Thank You page to confirm your form has been submitted.

PLEASE NOTE:

You will be contacted for the date and time of the next Volunteen orientation.

Each orientation session will now provide information on Patient Care. Although Patient Care is not mandatory for the majority of hospital assignments, it is a necessary curriculum for students who wish to have direct patient contact. Patient Care assignments are open to students who are at least 16 years of age or 15 years of age with one year of volunteer experience.

Contact the Lima Memorial Volunteer Services Department at 419-226-5094 for more information.

Featured Services

Cancer Institute

Heart and Vascular Institute

Same-Day Cardiology Appointments

Lima Memorial Physicians

You will need Adobe® Acrobat® Reader to view PDF documents. Download a free copy from the Adobe Web site.