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YOUTH VOLUNTEER APPLICATION
Personal Details
First Name
*
Last Name
*
Middle Initial
Address
*
City
*
State
*
ZIP
*
Telephone
*
Date of Birth
*
Age
*
Grade Completed
*
Email
*
School
*
Hobbies & Skills
*
List any physical handicaps or health problems that you would like us to know about
Are you interested in a health-related career?
Yes
No
If yes, specify
*
Department preference:
*
1st Choice
2nd Choice
3rd Choice
Hours & Days Available (Please click available days and times)
*
MON
TUE
WED
THUR
FRI
SAT
SUN
9:00-12:00
Morning
No
No
No
No
No
No
No
12:00-3:00
Afternoon
No
No
No
No
No
No
No
4:00-7:00
Evening
No
No
No
No
No
No
No
Reference
*
Telephone
*
Parent or guardian to call in case of an emergency:
*
Select
Mobile
Landline
Office
As a Junior Volunteer, I will attend orientation classes required by the Hospital to prepare to become a Youth Volunteer. I will uphold the standards of the hospital by respecting all rules and regulations. I will fulfill my assignment commitment to work a minimum of three (2-4) hours per week for a six month minimum.
Date
*
Sign Here
I hereby give permission for to become a member of the Youth Program at Providence & Saint John Hospitals. I consider him/her physically able and fully responsible to undertake the activities of a hospital volunteer.
*
Date
*
Sign Here