Required fields are marked with an asterisk *. Junior Volunteer ApplicationFirst Name: *Middle Name:Last Name: *Date of Birth: *GenderGender Male FemaleHome Telephone:Email: *Cell Phone:Name of School:Grade:Have you had any experience as a hospital volunteer?Have you had any experience as a hospital volunteer? Yes NoIf so, where?When?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? Yes NoAre you interested in a medical career?Are you interested in a medical career? Yes NoIf so, what branch?If yes, please explainDo you have any physician limitations that would limit your activityClubs and Societies you are a member of:Mother's Name:Mother - Cy-Fair Hospital Employee / Doctor: Yes NoWork Telephone:Father's Name:Father - Cy-Fair Hospital Employee / Doctor:Father - Cy-Fair Hospital Employee / Doctor: Yes NoWork Telephone:Name and phone numbers of two personal references: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.Do you have a preference for a particular type of work?Interviews will be conducted for all junior volunteer applicants this year.You will be notified of your interview date and time. If so, what?Patient Contact?Patient Contact? Yes NoA 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.Monday 9 AM to 1 PM 12 PM to 4 PMTuesday 9 AM to 1 PM 12 PM to 4 PMWednesday 9 AM to 1 PM 12 PM to 4 PMThursday 9 AM to 1 PM 12 PM to 4 PMFriday 9 AM to 1 PM 12 PM to 4 PMSaturday 9 AM to 1 PM 12 PM to 4 PMSunday 9 AM to 1 PM 12 PM to 4 PMCan you furnish transportation for yourself?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 agree I have permission from my guardian to participate in the Junior Volunteer Program at Cypress Fairbanks Medical Center Hospital. I agree Rate Your Experience Submit SuccessThe form was successfully sent. There was an error with the form submission.