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 *