I will consider as confidential all information which I may hear or see, directly or indirectly, concerning a patient, patient family member, doctor, or other health care professional and I will not seek information from any of the above in regard to a patient.
I hereby certify that the answers on this application and any resulting from interviews are true and correct and that any misrepresentations or omissions of facts, misleading, or false information on my part will be grounds for dismissal as a volunteer. Acceptance as a volunteer is contingent upon satisfactory references, verification of information submitted on the application and satisfactory completion of mandatory requirements. I authorize that all employers, schools, or references thus contacted be released from all liability in answering questions related to my application.
I understand that I am required to commit to serve a regular schedule of 6 months or more.
My services are donated to Nash UNC Health Care without contemplation of compensation or future employment and given with humanitarian or charitable reasons. By signing this form, I am authorizing Nash UNC Health Care, and those acting under its direction, to obtain and use any photos, video, electronic, or audio recordings in which I may be included.
I authorize Nash UNC Health Care to administer emergency medical treatment to me while volunteering. I understand that Nash UNC Health Care is not responsible for volunteers before or after their assigned shifts.