Jr. Volunteer Application-Parent/Guardian Consent

Junior Volunteer Program Applications and Parent/ Guardian Consent Form
Junior Volunteer name
ParentGuardian name
Address/City/Zip
Phone Number (home)
Please enter a valid phone number.
Phone (business)
Phone (cell)
Email
example@example.com
Addl emergency contact name
(phone)
I understand as a junior volunteer I am responsible to:
1. Be punctual for each shift
2. Notify volunteer coordinator in case of illness, vacation, or any other time away
3. Give sufficient notice of resignation if you cannot fulfill your volunteer obligation
4. Provide a record of previous immunizations
5. Complete the summer program to be considered first for other volunteer opportunities.
Junior Volunteer Signature

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I, parent or guardian, give my permission for the following:
1. Immunity Review completed by our Occupational Health Department
2. In the event immunization records are incomplete, a blood draw will be administered.
3. Any medical treatment necessary in the event of illness or injury
4. Orientation, training, and assignment specified areas of the hospital
Please list any health condition which might impact or limit the volunteers work at the hospital
parent or guardian signature

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