Junior Volunteer Application

 
 
 
 
Gender:
Gender:
 
 
 
 
 
 
Have you had any experience as a hospital volunteer?
Have you had any experience as a hospital volunteer?
 
 
 
Are you a returning Junior Volunteer of the program at Cypress Fairbanks Medical Center Hospital?
Are you a returning Junior Volunteer of the program at Cypress Fairbanks Medical Center Hospital?
 
Are you interested in a medical career?
Are you interested in a medical career?
 
 
 
 
 
 
Mother – Cy-Fair Hospital Employee/Doctor:
Mother – Cy-Fair Hospital Employee/Doctor:
 
 
 
Father – Cy-Fair Hospital Employee/Doctor:
Father – Cy-Fair Hospital Employee/Doctor:
 
 
 
NOTE: In the box provided below, please write a brief essay telling us why you are interested in doing volunteer work and what you feel you may contribute to our program.  Applications received without essays will not be considered.
 

Interviews will be conducted for all junior volunteer applicants this year.You will be notified of your interview date and time. 

 
 
Patient contact?
Patient contact?
 

A MINIMUM OF 4 HOURS OF SERVICE PER WEEK IS REQUIRED.

Our shifts are 9 a.m. to 1 p.m. and 12- 4p.m.

When are you available to work 4 hours?  Check only the times when you are available.  
Day
              AM
            PM
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
 

When I am accepted as a volunteer at Cypress Fairbanks Medical Center Hospital, I pledge that I will work to complement the excellent medical care that is given at the hospital. I promise to read, learn and follow the rules and ethics for volunteers in the handbook. I will consider strictly confidential all information which I may hear directly or indirectly concerning a patient, doctor or any member of the hospital staff. I will always inform the Junior Volunteer Coordinator if I cannot be on duty at my assigned time.

 I have permission from my guardian to participate in the Junior Volunteer Program at Cypress Fairbanks Medical Center Hospital.