High School Volunteer Application

Applicant Information
First name *
Last Name *
Email Address
Address *
City *
State *
Zip *
Home Phone * (123-456-7890)
Date of Birth * mm/dd/yyyy
Year Graduating
Name of High School Attending
Grade Point Average *
(take from last report card)
Name of Parent(s) or Guardian *
Emergency Contact (Name) * Phone * Relationship
References (Please provide name and phone number of two references. Not relatives)
Name Phone
Please list extra-curricular activities including volunteer experience
Skills/Hobbies
Reason(s) for wanting to volunteer
High School Volunteers are asked to commit to 4 or more hours per week. Please list preferred days of
week (Sunday through Saturday). Hours are from 8:00 am to 8:00 pm.
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
From:
To:
 

I hereby apply for the High School Volunteer program and certify that the above statements are true and
correct. I understand and agree to comply with the requirements and regulations of the Hospital.

Signature * (Please type your full name)            Date *