In addition to the application, please print and complete a Minor Volunteer Consent Form. Name First Name Last Name Date of Birth Address Address Address 2 City/Town State/Province - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code Phone Number Is this a cell phone? Yes No Alternative Phone Number Email Address Emergency Contact Name Emergency Contact Name First Name Last Name Emergency Contact Phone Number Emergency Contact Relationship Name of High School What year in high school? Freshman Sophomore Junior Senior Please list any current or previous work or volunteer experience. Why are you interested in volunteering at Rush Copley? What areas interest you? CLERICAL (most seated repetitive work, scanning, filing, document preparation, data entry) GIFT SHOP (some standing, point of sale, stocking, pricing, setting up displays, customer service) GREETER/ESCORT (assisting patients in wheelchairs, walking throughout the hospital, customer service, information desk, some computer work) MUSIC THERAPY (play an instrument) PASTORAL/SPIRITUAL CARE PATIENT CARE (some physical tasks requiring bending, pushing or lifting, standing and walking, answer call lights, muct be 18 years or older) PET THERAPY (must have a certified dog) TRANSPORTATION (drive golf cart/van) WATERFORD PLACE (help with laundry, washing yoga mats, light cleaning, set up ad tear down for presentations) What type of commitment are you interested in? Year-round Summer Please indicate your availability. Morning (8 a.m. to 12 p.m.) Afternoon (12 to 4 p.m.) Evening (4 to 8 p.m.) Which days of the week are you available? Sunday Monday Tuesday Wednesday Thursday Friday Saturday Other comments on availability Favorites What is your favorite candy? What is your favorite snack? What is our favorite store? What is your favorite restaurant? Additional InformationMost teen volunteers do one 3-4 hour shift per week.Shifts and assignments stay the same from week to week.There are not always available opportunities in each service area. Applicants will be contacted when opportunities match applicant’s availability and interest area.Applicants are contacted in the order applications are received.Applications are kept for 3 months from application date.Volunteer RequirementsAll volunteers are required to complete necessary registration paperwork, an interview with the Volunteer Services Manager, and an orientation session prior to starting service.In addition all volunteers are required to:Be fully vaccinated for COVID-19 (proof of vaccine required)Complete a COVID-19 waiverBe at least 16 years oldComplete an initial 2-step TB test (performed free of charge by Rush Copley Family Practice Center)Provide vaccination records for MMR, Varicella and Tdap or have a blood titer drawn to verify immunity.Receive an annual flu shotAttend an annual training meeting offered through Volunteer Services Year round volunteers: commit to 6 months of consecutive volunteer service or 100 hours, whichever comes firstSummer volunteers: commit to 11 weeks of consecutive volunteer service Agreement I have read and agree to the volunteer requirements above. Leave this field blank
In addition to the application, please print and complete a Minor Volunteer Consent Form. Name First Name Last Name Date of Birth Address Address Address 2 City/Town State/Province - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code Phone Number Is this a cell phone? Yes No Alternative Phone Number Email Address Emergency Contact Name Emergency Contact Name First Name Last Name Emergency Contact Phone Number Emergency Contact Relationship Name of High School What year in high school? Freshman Sophomore Junior Senior Please list any current or previous work or volunteer experience. Why are you interested in volunteering at Rush Copley? What areas interest you? CLERICAL (most seated repetitive work, scanning, filing, document preparation, data entry) GIFT SHOP (some standing, point of sale, stocking, pricing, setting up displays, customer service) GREETER/ESCORT (assisting patients in wheelchairs, walking throughout the hospital, customer service, information desk, some computer work) MUSIC THERAPY (play an instrument) PASTORAL/SPIRITUAL CARE PATIENT CARE (some physical tasks requiring bending, pushing or lifting, standing and walking, answer call lights, muct be 18 years or older) PET THERAPY (must have a certified dog) TRANSPORTATION (drive golf cart/van) WATERFORD PLACE (help with laundry, washing yoga mats, light cleaning, set up ad tear down for presentations) What type of commitment are you interested in? Year-round Summer Please indicate your availability. Morning (8 a.m. to 12 p.m.) Afternoon (12 to 4 p.m.) Evening (4 to 8 p.m.) Which days of the week are you available? Sunday Monday Tuesday Wednesday Thursday Friday Saturday Other comments on availability Favorites What is your favorite candy? What is your favorite snack? What is our favorite store? What is your favorite restaurant? Additional InformationMost teen volunteers do one 3-4 hour shift per week.Shifts and assignments stay the same from week to week.There are not always available opportunities in each service area. Applicants will be contacted when opportunities match applicant’s availability and interest area.Applicants are contacted in the order applications are received.Applications are kept for 3 months from application date.Volunteer RequirementsAll volunteers are required to complete necessary registration paperwork, an interview with the Volunteer Services Manager, and an orientation session prior to starting service.In addition all volunteers are required to:Be fully vaccinated for COVID-19 (proof of vaccine required)Complete a COVID-19 waiverBe at least 16 years oldComplete an initial 2-step TB test (performed free of charge by Rush Copley Family Practice Center)Provide vaccination records for MMR, Varicella and Tdap or have a blood titer drawn to verify immunity.Receive an annual flu shotAttend an annual training meeting offered through Volunteer Services Year round volunteers: commit to 6 months of consecutive volunteer service or 100 hours, whichever comes firstSummer volunteers: commit to 11 weeks of consecutive volunteer service Agreement I have read and agree to the volunteer requirements above. Leave this field blank
