Volunteer Application Form

Name

First NameLast Name

Phone Number

Format: (000) 000-0000.

E-mail

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Days Available

Time Period of Day Available

8am-12pm12pm-4pm4pm-8pmOther

If you chose "other" to the above question, please list what time period works best for you.

Areas of Interest

Main Lobby- Info desk, greet visitors/patients, help with directions, room numbers, wheelchairs, keep lobby tidy and welcomingSurgery Waiting- Greet patients and visitors, act as liaison between pre and post-op, offer coffee and reading materialsER- Info desk, greet visitors/patients, provide directions, offer tissues/comfort items during high volume, etc.Care Cart- Take a cart of basic items from unit to unit, visiting patients and offering reading materials, small personal care items (ie: chapstick, lotion, reading glasses)Chaplain- Be willing to take call and come visit patient as requested. Can be lay person – ordination not required.Other- light office work, phones, filing in Sr. Friends, concierge and way-finding at an outpatient clinic, etc.

If you chose "other" to the above question, please list your areas of interest.

Please describe why you are interested in volunteering at Lake Cumberland Regional Hospital.