CONSENT TO PARTICIPATE FOR MINOR

I consent to allow   First Name   Last Name   , a minor, to participate in volunteer activities at Good Samaritan. I understand that our student’s services are donated to the hospital without financial compensation or future employment.

• I release the hospital and its employees from any claim of liability for any damages, injuries or illnesses while participating in such volunteer activities. (If medical attention is needed, the volunteer may see his/her own physician or go to Emergency Services, by his/her choice and at his/her expense.)
• I understand that all student volunteers at Good Samaritan are required to turn in a copy of their immunization records and obtain any immunizations that the hospital requires for student volunteers.
• I understand that all volunteers must participate in MANDATORY Orientation.
• I understand that students must be able to fulfill six of the seven weeks of the program to be eligible to participate.
• I understand that volunteers are expected to make their best effort in fulfilling their commitment to the hospital by completing all assignments that they accept. Unscheduled absences will result in termination of the student's participation in the program (no exceptions).
• I understand that volunteers are expected to be professional in appearance, punctual and conscientious. They should conduct themselves with dignity, be courteous and considerate of others, while striving to make their work professional.
• I understand that cell phones are to be used for emergencies only and will be put away during the scheduled volunteer time.

By signing below, parent/guardian and student both agree you have read the provided information and agree to comply with these conditions.