Volunteering at Palisades Medical Center

Volunteer Application - Adult

Complete the form below to join our volunteer team!

Address

Date of Birth

Employer Information

Address

In Case of Emergency or Illness

Education

Schedule Availability

Please list times for each day of the week that you are available.

Agreement

I agree to abide by the requirements and regulations of Palisades Medical Center and the service to which I am assigned. I will serve a minimum of eighty (80) hours after participating in required training. Letters of recommendation will not be issued prior to completion of 80 hours of volunteer time.

I authorize Palisades Medical Center and the Palisades Medical Center Foundation to use my name and/or photograph in marketing materials to help promote Volunteer Services at Palisades Medical Center.

Volunteer Application - Teen

Complete the form below to join our volunteer team!

Address

Date of Birth

Parent Guardian

Address

Emergency Contact Information

(if different from parent/guardian)

School Information

School Address

Schedule Availability

Please list times for each day of the week that you are available. (Actual commitment time will be determined during interview with the Coordinator of Volunteer Services.)

Agreement

I agree to abide by the requirements and regulations of Palisades Medical Center and the service to which I am assigned. I will serve a minimum of sixty hours (60) after participating in required training. Letters of recommendation or acknowledgement of Volunteer Service will not be issued prior to completion of 60 hours of volunteer service.

Parent/Guardian Agreement

My son/daughter is 15 years of age or older, has successfully completed the first year of high school, and has my permission to volunteer at Palisades Medical Center. I realize the responsibilities of this position and will cooperate to help him/her to comply. I authorize Palisades Medical Center and the Palisades Medical Center Foundation to use my son's/daughter’s name and/or photograph in marketing materials to help promote Volunteer Services at Palisades Medical Center.

Illness or Injury

In the event that my child becomes ill or injured while volunteering and I cannot be reached, I hereby give my consent to have him/her treated by a staff physician.

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