Volunteer Application
Name
*
First Name
Last Name
Age:
*
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Expectations:
Expectations of volunteers include: assisting therapists as needed, calling patients for scheduling changes, bringing patient's back to therapy area, doing clinic laundry (towels), cleaning therapy supplies, taking out trash, and refilling soap dispensers/paper towels.
What skills do you have that will make you a great volunteer at our clinic?
*
List any other facilities that you have volunteered or worked?
*
What do you hope to gain out of volunteering at our facility?
*
Do you know anyone who works within our company? Do you know any therapists?
*
Are you able to maintain confidentiality of our patient information and business practices?
*
Yes
No
Are you willing to commit to at least 4 hours per week over a 6 week rotation?
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Yes
No
Which office location/s are you interested in volunteering at?
*
Beulaville, NC
Goldsboro, NC
Jacksonville, NC
Smithfield, NC
Wilmington, NC
Nashville, NC
Lincolnton, NC
Kings Mountain, NC
Mount Airy, NC
Yadkinville, NC
Northside, FL
Yulee, FL
Bartrum, FL
Jacksonville, FL
Electronic Signature
*
Clear
Date of signature:
*
-
Month
-
Day
Year
Date
Submit
Should be Empty: