Hospice Volunteer Application

Hospice Volunteer Application
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
YesNo
Foreign Language(s) Spoken Fluently
I bring the following work/volunteer experience and skills:*
Confidentiality and Commitment Statement

I understand and agree that in the performance of my duties as a volunteer at Ridgecrest Regional Hospital, I must abide by all policies and procedures, including to hold as strictly confidential all medical information that I may obtain directly or indirectly concerning patients. I understand that failure to comply with these requirements may result in my dismissal as a volunteer.

I am volunteering my services to Ridgecrest Regional Hospital solely for my personal purposes or benefit without promise or expectation of compensation or benefits. I agree to serve as a volunteer without salary for a period of 100 hours or more.
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