Junior Volunteer Application Form

Click here to download the junior volunteer application form. You may complete this form and mail them to Junior Volunteer Application Form, New London Hospital.

 

First Name:

Last Name:

Phone:

E-mail:

Address:

City:

State:

Zip:

Name of Parent or Guardian:

Father Business Address:

Phone:

Mother Business Address:

Phone:

School Presently Attending:

Grade:

Graduation Year:

GPA:

Previous volunteer experience:

Hobbies/Sports:

Clubs/Memberships:

When you think of volunteering, what kinds of things interest you?

What do you hope to gain from your volunteer experience?

Please indicate the hours that you will be available:

 

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Morning

After-School

Evening

As a student volunteer, I understand that I am required to:

  • Be over 16 years of age
  • Maintain at least a 2.5 (C+) GPA
  • Have a written consent form from a parent or guardian
  • Have a referral from a school counselor or principal
  • Follow the hospital rules and regulations
  • Works one regularly scheduled shift per week
  • Commit to one semester (marking period)
  • Contact the Volunteer Manager immediately regarding any absences from duty. Failure to do so may result in termination from the volunteer program.

Signature:

Date:

Parents:
I understand the Rules and Regulation(s) for my teen to participate in the Junior Volunteer Program at New London Hospital and hereby give my consent and support.

Signature:

Date:

FOR OFFICE USE ONLY
Date of Application Received: ______/_______/_______      

Orientation Date: ______/_______/_______

Service Area: _______________________________________

Shift: ________________________

Department Supervisor: __________________________________________