Volunteer Service Application An Equal Opportunity Program
Last Name:
First Name:	MI:
S.S.#:
Address:
City:
State:
Zip Code:
Home telephone:
Business telephone:
In case of emergency, please notify:
Relationship:
Home telephone:
Work telephone:
Please indicate age group: 15-17 40-59 18-39 60 and over
Employment:
Indicate Current Job or Most Recent Job and End Date
Employer:
Employer phone number:
Position:
Hours per week:
Education:
I have completed:
Degree or Major:
Current enrollment location:
Subject/Major:	Year:
Full-time Part-time
List courses relating to your volunteer interest:
Availability:
I would be able to volunteer: (check all that apply)	Evenings Weekends Weekdays
Hours available:
Beginning (month/year):
Interests:
How did you become interested in volunteering at Children´s:
What would you most like to do as a volunteer:
Would You Prefer to Volunteer…
Directly with Children Volunteers must be over 18 (Check all that apply) Child Life/Patient Care Emergency Room/Triage Area Family Library Project Champ/HIV Support Presurgical Tour Program Sibling Waiting Area Other:	Other Service Areas General Support Services Volunteer must be 15 or over (Check all that apply) Welcome Desk Volunteer Office Blood Donor Center Regional Outpatient Centers Special Events/Projects Clerical Support Other:
Experience:
Please list previous volunteer service:
Organization:
Dates:
Hours served:
Responsibilities:
Organization:
Dates:
Hours served:
Responsibilities:
Organization:
Dates:
Hours served:
Responsibilities:
List experience you have with children (including your own) and age groups:
List any other experience or skills related to your volunteer interests (teaching, language, etc.):
List organizations or clubs in which you are active:
Health:
Is there any health reason which might limit your ability to volunteer?
YES NO If yes, please explain
References:
Please print names and addresses of three persons we may contact who have known you for more than one year (excluding relatives, roommates, or friends).
Last Name:
First Name:	MI:
Address:
City:
State:
Zip Code:
Telephone:
Last Name:
First Name:	MI:
Address:
City:
State:
Zip Code:
Telephone:
Last Name:
First Name:	MI:
Address:
City:
State:
Zip Code:
Telephone:
I understand volunteers must be 15 years of age, agree to serve a regular placement of at least 100 hours in a calendar year (50 hour commitment for high school volunteers), and submit a health form, references, and fulfill other requirements before beginning volunteer service. I also authorize for release of general information given on this application.