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Volunteen Application

Please complete the fields below.

Requirements

First Name *

Middle Initial *

Last Name *

Preferred Name

Age (as of May 1, 2025) *

Date of Birth *

Home Address *

City *

State *

Zip Code *

Email Address *

Cell Phone Number *

Parent's Name(s) *

Emergency Contact First and Last Name *

Emergency Contact Relationship *

Emergency Contact Preferred Phone Number 1 *

Emergency Contact Preferred Phone Number 2

Emergency Contact Email Address *

High School Name *

Graduation Year *

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

Yes

Guidance Counselor name

Please mark the volunteer service area(s) you are interested in: *

Clerical

Gift Shop

Information Desk Greeter

Nursing Unit Assistant

Occupational / Physical Therapy Assistant

Patient & Visitor Escort

Other volunteer service (Do you have something else in mind that isn't listed above? Please list it here):

Any other scheduling requests you may have:

Please list any extracurricular activities that might interfere with your ability to fulfill your schedule (i.e. sports, band, camp, family vacation). *Please note that this does not disqualify you from volunteering, it's more to help us with scheduling. *

Please tell us why you want to volunteer: *

Career Interests: *

What hobbies do you have? *

Date *

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