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Are you currently a student?
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Do you have previous volunteer experience?
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Indicate the day(s) of the week you are available to volunteer as well as the starting shift schedule you would
prefer. If you are flexible in the days of the week and starting time, please place a check in any of the boxes
based on your availability. This information will help us determine the position openings that may be of interest
to you when you meet with the Volunteer Recruiter.
Monday
Tuesday
Wednesday
Thursday
Friday
Morning
Afternoon
Evening
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Please provide two references - a teacher, counselor, or clergy. Family members will not be accepted.
I give permission for the above reference(1) to release information regarding my teen.
Typed Name Constitutes Signature
I give permission for the above reference to release(2) information regarding my teen.
Typed Name Constitutes Signature
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APPLICATION ESSAY: Write a 150-200 word essay describing how volunteering at Akron Children's Hospital would impact your life and why you should be selected as a volunteer. Applicants will be judged on originality, punctuation and grammar. Successful essays will incorporate your motivation for volunteering as well as a desire to meet new people, give back to the community and help the patients, siblings and families.
School Leadership or Participation: Student Council, Class Officer, Band, Chess Club, Athletics, NHS, Etc.
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Currently employed
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I hereby affirm that the
information provided on this application is true and complete. I understand that any false or misleading
representations or omissions may disqualify me from further consideration for volunteer service and may result in
discharge even if discovered at a later date.
I authorize Akron Children's
Hospital to verify any information I have provided. I hereby authorize persons from any schools, companies, or
organizations, to include my references, named in this application to provide information about me contained in
their records, and I release all such persons from liability regarding the provision of or use of such information.
I understand there are certain
training requirements that must be fulfilled, and performance standards that must be maintained in order to
volunteer at Akron Children's Hospital.
Finally, as an Akron Children's
Hospital volunteer, I will:
Agree to volunteer for a minimum of 50
hours.
Notify Volunteer Services any time I am
unavailable to volunteer for my assignment.
Decline to perform any task for which I
feel I have not been adequately trained or which would put me or others at risk.
Respect patient, family, and staff
confidentiality; which I understand is both a patient right and the Hospital's legal responsibility. Users of
electronic, verbal, or written information systems have the same obligation regarding confidentiality.
Abide by the rules and regulations of
Akron Children's Hospital and Volunteer Services.
Maintain the customer service standards
in my interactions with patients, families, and staff.
Permit images of photos of me in my role
as a volunteer to be used in public relations brochures or videos.
Volunteers under the age of 18 need the signature of a parent or guardian. As the parent or guardian of the above
prospective minor volunteer, I support and recommend him/her in this opportunity. Also, I have read the statement
of commitment and my teenager,
has my permission to become a volunteer at
Akron Children's Hospital.
I understand documentation of two MMR's, Varicella (Chickenpox), Tdap or Td (as indicated in the past 10 years),
and completion of Hepatitis B series is necessary to volunteer.
Also, an initial Tuberculosis Skin Test as well as an annual flu vaccine are required for volunteering; therefore,
I give permission for my child to have this test and vaccine completed at Akron Children's Hospital. I understand
that there is no charge for this service.
Typed Name Constitutes Signature
Parent/Guardian Information
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