2008 Junior Volunteer Application
Name________________________________________________ Phone Number ________________________
Address____________________________________City/State/Zip__________________________Age______
Date of Birth_____________ Name of Parent or Guardian__________________________________________
EMERGENCY NOTIFICATION _____________________________________Phone____________________
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School_________________________________________ Current Grade Level ___________________
Are you Earning Hours for School? ______ How Many? ______ School Name ________________________
References: (One must be from a teacher or counselor. Do not list relatives.)
Name___________________________________ Name _____________________________ญญญญญญ_______
Phone Number____________________________ Phone Number _____________________________
List previous Volunteer Experience_________________________________________________________
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State why you wish to volunteer at Opelousas General Health System._______________________________
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State what area/department you would like to volunteer __________________________________________
____________________________________________________________________________________
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Dates and times you will be able to volunteer
Days _______________________________________ Time ____________________________________
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As a member of the Junior Volunteer Services of Opelousas General Hospital I agree to abide by all rules and regulations of Opelousas General Hospital and attend all orientations deemed mandatory.
Student Signature: ____________________________________________ Date: ______________________
Parent/Guardian Signature: _____________________________________ Date: _______________________ |