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Volunteer Application Form
Check which one applies to you:
Address Line 1
Address Line 2
Donation Matching Program
Not currently studying
Highest level of education completed
No High School
Some High School
Two year Degree
Four year Degree
Describe your reasons for choosing to volunteer at Children's Hospital.
Monday 9 AM - 12 PM
Monday 1 - 4 PM
Monday 5 - 8 PM
Tuesday 9 AM - 12 PM
Tuesday 1 - 4 PM
Tuesday 5 - 8 PM
Wednesday 9AM - 12PM
Wednesday 1 - 4 PM
Wednesday 5 - 8 PM
Thursday 9 AM - 12 PM
Thursday 1 - 4 PM
Thursday 5 - 8 PM
Friday 9 AM - 12 PM
Friday 1 - 4 PM
Friday 5 - 8 PM
Saturday 9 AM - 12 PM
Saturday 1 - 4 PM
Saturday 5 - 8 PM
Sunday 9 AM - 12 PM
Sunday 1 - 4 PM
Sunday 5 - 8 PM
Are you required to volunteer, shadow or perform community service?
If yes, by whom?
How many hours?
When do the hours need to be completed?
Describe the volunteer experience(s) you've had, especially your experience with children.
What would you like to do as a Children's Hospital volunteer?
Is there anything else you would like for us to know?
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 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 a volunteer. As a volunteer, I acknowledge that I will not receive compensation for services.