In Order to Complete This Form

You will need three persons present:

  1. Junior Volunteer Applicant
  2. Parent or Guardian
  3. Counselor or Teacher

Requirements for Junior Volunteers

  1. Age: Applicants must be at least 15 years of age to apply.
  2. Applications: All prospective volunteers must file an application with the Volunteer Office. Filing an application does not assure placement. Choice of applicants is determined on the basis of personal qualifications and traits judged by the Volunteer Staff to be suitable and in the best interest of the Hospital.
  3. Interview: Applicants will be contacted to schedule a personal interview with the Director or Coordinator of Volunteer Services. Although not required, parents are welcome to attend the interview so they will understand the commitment expected of their teen.
  4. Health: Volunteers are expected to be in good physical and mental health, and must complete all health requirements prior to volunteer services.
  5. Willingness: Volunteers must have a sincere desire to perform community service and a willingness to cooperate in all areas of assignment.
  6. Responsibility: The volunteer should have a genuine sense of responsibility to the hospital and the assigned tasks. Volunteers must accept the rules which apply to the Junior Volunteer Program.
  7. Dependability: Volunteers are expected to be faithful in attendance, advising of planned absences in advance, and always notifying the Volunteer Office of last minute cancellations.

*Indicates required information

Applicant Information
Date format should be: mm/dd/yyyy
Phone format should be: 000-000-0000
Phone format should be: 000-000-0000
In case of emergency, please notify
Phone format should be: 000-000-0000
General information
(Hobbies, sports, special interests, or foreign/sign language skills that you may have)
(Please check applicable boxes.)
(Please check applicable boxes.)
Applicant digital signature

I have read and understand the above requirements and wish to apply to the Marymount Hospital Junior Volunteer Program.

Parent/Guardian digital signature

I have read the above information and give my permission for my son/daughter, to participate in the Junior Volunteer Program at Marymount Hospital, to complete a Junior Volunteer Application Form, to receive a Tuberculin Screening Test, and to verify his/her 2nd MMR (Measles, Mumps, Rubella) inoculation.

Parent/Guardian consent - release information

I authorize the release of information from my son/daughter's school records to the Volunteer Resources Department of Marymount Hospital.

Confidential recommendation for Junior Volunteer

Each student who applies for volunteer work must have a recommendation from school. We would appreciate your evaluation and comments to help us choose candidates who will best benefit from our program and serve our organization and the recipients of our services. This information will be kept confidential. Please fill out the information below.

Phone format should be: 000-000-0000