Youth Volunteer Application

Youth Volunteer Application

Youth Volunteer Guidelines

Please provide the following information when applying for a volunteer opportunity:

Submit a copy of your most recent grades
Submit a letter of referral as part of the application and acceptance process for volunteer services at Providence Medical Center/Saint John Hospital. Your letter must:

  • be submitted by a teacher, counselor or professor of your choice
  • be on school letterhead
  • include the student’s full name
  • include the number of years they have known the student, as well as in what capacity
  • explain why they would recommend this student for the volunteer opportunity
  • be signed by you with your position title

Youth Volunteer Application

Last Name
First Name
Middle Initial
Street Address
Street Address 2
Zip/Postal Code
School Name
Location Preference
Father's Name
Father's Home Phone
Father's Work Phone
Mother's Name
Mother's Home Phone
Mother's Work Phone
Name of Guardian (If not living with parent)
Guardian's Home Phone
Guardian's Work Phone

If we are unable to reach a parent in case of emergency, who would be our next contact person?

Emergency Contact Name
Emergency Contact Phone
Emergency Contact Relationship
What do you hope to gain from your volunteer experience?
Do you have a relative that is employed or volunteers at Saint John?

If yes, please provide details:

Are you currently interested in a health-related career?
If yes, what is your field of interest?
Please indicate the best day of the week and hours (i.e. 4-8 p.m.) for your volunteer service
Please indicate Shirt Size (Polo style volunteer shirts are unisex and in men’s sizes.)
The cost of the uniform is $15 dollars. If this creates a financial hardship and you need a loaner please check here. Yes, I need a loaner shirt
I will accept a minimum of a 6 month commitment.
Youth Volunteer Signature (Please Type In Your Full Name)
Parent/Guardian Signature (Please Type In Your Full Name)
Volunteer Birthdate