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Junior Volunteer Form

Junior Volunteer Application

This program is for high school students 15 to 18 years of age or newly graduated seniors, with a 2.5 or better GPA.

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

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.
Permission to participate