King’s Daughters Medical Center > About > Junior Volunteers > Volunteer Application

Volunteer Application

Volunteer Application
Name
Name
First
Middle
Last
Address
Address
City
State/Province
Zip/Postal
Do you have any physical limitations which might prevent you from performing certain activities?
How did you hear about the Volunteer Program at King’s Daughters Medical Center?

In the event of an emergency, please list two individuals to be notified:

Please indicate the days and hours that you will be available on a regularly scheduled basis at King’s Daughters Medical Center:

a.m. shifts are 8:30-12:30, and p.m. shifts are 1-5.
From
Until
From
Until
From
Until
From
Until
From
Until
Would you be available to provide substitute service for another volunteer who might be unable to come in on a regularly scheduled day?

Please list two individuals, other than relatives, as personal references:

In making this application to serve as a member of the King’s Daughters Medical Center Volunteer Program, I hereby agree to abide by all existing rules and regulations of the Medical Center and the Volunteer Program and all new rules and regulations which may be enacted from time to time.