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Volunteer Agreement

* Indicates required information

First Name * 

Last Name * 

If I am accepted as a volunteer, I agree to:  

Keep all information regarding patients/clients confidential.  * 

Give permission for the Volunteer Services staff to discuss my work history and performance with those I have listed as supervisors and references and with my potential HCH supervisor(s). * 

Sign in and out each day I volunteer according to the protocol set up for my particulars area. * 

Promise to volunteer a minimum of 100 hours per area. * 

I understand verbal or written verification of hours will only be given after I have contributed the minimum of 100 hours.  * 

Always be punctual and regular in attendance. * 

Notify my supervisor(s) in advance if I cannot work my schedule. * 

Wear the hospital I.D. badge while on volunteer duty.  * 

Purchase my own volunteer jacket (new $20, used $10) and wear it whenever on duty. * 

I understand that I can return my new volunteer jacket when I resign for a refund ($10) if the following conditions are met: The hospital is still using my style of volunteer jacket, the jacket is unstained, my I.D. badge is returned. * 

I won’t expect compensation or employment as a result of my volunteer work. * 

Provide my own transportation to and from the volunteer work site at my expense. * 

Notify my supervisor(s) and the Director of Volunteer Services of my plan to resign at least two weeks in advance. * 

Return my hospital I.D. badge to Volunteer Services on my last day. * 

Abide by Holy Cross Hospital policies and procedures. * 

Have a background check (for 18 years and older). * 

I certify that: 

I am at least 14 years old.  * 

I am not volunteering as a court requirement or as an attorney referral. * 

I have never been convicted of a crime. * 

Please sign and date below: 

Date * 

(mm/dd/yyyy)

Electronic Signature * 

 
©  2014 

Holy Cross Hospital | 1500 Forest Glen Road, Silver Spring, MD 20910 | 301-754-7000