New User Details
User ID (verify)
Teen Application Form
Address Line 1
Address Line 2
Not currently studying
Describe your reasons for choosing to Volunteer at Children's Hospital.
Which of the following duties would you be of most interest to you?
Greeting and escorting families and patients
Assisting with wheelchair transport
Visiting patient areas with the Art Cart or Comfort Cart
Providing support for patients and nursing staff on nursing units
Delivering mail flowers to hospitalized children
Assisting playroom coordinator during playroom activities
Entering data into computers
Providing clerical assistance (filing copying answering phones etc.)
Teen Ambassadors schedule will be set up prior to the first day of orientation. A minimum of 10
hours each week for 6 of the 9 weeks is required
How many day of week do you plan to volunteer?
Monday 8am - 12pm
Monday 1pm - 5pm
Tuesday 8am - 12pm
Tuesday 1pm - 5pm
Wednesday 8am -12pm
Wednesday 1pm - 5pm
Thursday 8am - 12pm
Thursday 1pm - 5pm
Friday 8am - 12pm
Friday 1pm -5pm
Provide three reasons why you would like to be a Teen Ambassador.
What does the phrase 'Patient Experience' mean to you?
What skills and/or qualities would you bring to the Teen Ambassador Program?
What size is your polo Shirt?
Proposed Educational Purpose: (What are your goals?/What do you hope to achieve?)
In case you become sick or injured while volunteering, please list the emergency contact information for the person you want notified.
Address Line 1
Address Line 2
1. Documentation of two MMR vaccinations and two Varicella vaccinations or titer test for the measles, mumps, rubella and varicella. If there is no documentation of two vaccinations or titers are not positive for the measles, mumps, rubella and varicella, then further vaccination is needed.
2. Current TB test (TB tests are required annually) or Blood Assay Test within last 6 months.
3. Proof of Annual Flu Vaccination (Flu vaccine)
4. Copy of vaccination records, up to date on all vaccinations
5. Tdap immunization (Whooping Cough)
Adults (18 years and older) will be required to fill out a background authorization form at the time of their interview granting Children's Hospital permission to perform a background check.
Confidentiality Agreement & Photo Release
I understand and agree that in the performance of my duties as a Volunteer of Children's Hospital Health Care System I must hold in strictest confidence any observations I may make or information I may hear regarding patients, patient families or staff.
I verify that the information provided by me on this application is true, correct and complete. I attest that I haven't ever been arrested or charged with any crime and grant Children's Hospital permission to verify this information in arriving at a decision.
I understand that any false or misleading statements or the omission of any information necessary to make this application complete will result in refection of my application or termination of my service.
Additionally, Children's Hospital has my consent to photograph, video tape, or audio tape me performing my Volunteer duties. I understand that these may be used toward the advancement of public education, the promotion of Children's Hospital, and/or any other legitimate purpose.
I understand that upon my successful completion of the Volunteer placement processes required at Children's Hospital, I will become aVolunteer. As a Volunteer, I acknowledge that I will not receive compensation for services.