Become a Lima Memorial Volunteen

LMHS Volunteen Application

Please complete the fields below.

Please note, in accordance with the CMS COVID-19 vaccine requirement and to create a safe environment, LMHS requires all Volunteens to be “fully vaccinated,” meaning they must have received the single-dose Johnson and Johnson vaccine or both doses of the two-dose Moderna or Pfizer vaccine, or complete a medical or religious exemption form. Contact the Lima Memorial Volunteer Services Department at 419-226-5094 for more information.

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 *

Grade Entering in Fall 2022 *

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: *

Please check any shifts that you are interested in working: *

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.

Become a Lima Memorial Volunteen

LMHS Volunteen Application

Form Submission

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