Volunteer Application - Teen


Address

 

Demographic Information (Optional)

Please help us to maintain our database for reporting purposes.

Today

Phone Numbers

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Emergency Contacts

In emergency, please notify:

Emergency Contact 1:

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Emergency Contact 2:

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Emergency Contact 3:

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Physician

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Dentist

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Preferred Hospital

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High School

School Contact

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Have you had a significant loss in the last year?

It is required that prospective volunteers wait 12 months after experiencing a significant loss through death or divorce before volunteering with patients. You many still volunteer in other roles that do not have patient contact. Please answer yes or no and let us know the date of the loss.

It is required that prospective volunteers wait 12 months after experiencing a significant loss through death or divorce before volunteering with patients. You many still volunteer in other roles that do not have patient contact. Please answer yes or no and let us know the date of the loss.

Type of Volunteering

Please let us know what type of volunteering you are interested in doing: Other support would include fundraising, community outreach, marketing/recruiting, etc.

Please let us know what type of volunteering you are interested in doing: Other support would include fundraising, community outreach, marketing/recruiting, etc.

I Agree

Hospice of the Western Reserve and the volunteer applicant acknowledge that the training classes are a time of exploration and attendance does not guarantee volunteer placement.

Hospice of the Western Reserve and the volunteer applicant acknowledge that the training classes are a time of exploration and attendance does not guarantee volunteer placement.