Volunteer Application
Name
First Name
Last Name
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Are you interested in taking our health and hospice training course to qualify to assist people through their final or short term medical stages of life?
Yes
No
Are you willing to be an active member by (check all that apply)?
Drive a patient to doctor’s appointments
Prepare meals for a patient
Helping a patient with task such as grocery shopping, running errands, paying bills, etc.
Visiting home bound patients
Are you will to help BHHF with (check all that apply)?
Marketing and publicity
Fund raising
Making a monetary donation
Administrative tasks
Spanish ability?
Rows
Fluent
Some
Unable
Speaking
Reading
Writing
I understand that a cornerstone of providing health and hospice care support is to keep all matters confidential, and I agree to do so.
Agree
Not able to do so
Anything you want to add?
Submit
Should be Empty: