Required fields are marked with an asterisk *.

Junior Volunteer Registration Form

Medical City Fort Worth

Are you employed?
Have you been convicted of any crimes?
Do you have previous volunteering experience?
Days preferred?

Two personal references (No Relatives)

Any illness in the last year?
Any medications currently being taken?
Are you allergic to any drugs?
Do you have any limitations?

I UNDERSTAND THAT IN ORDER TO BE A JUNIOR VOLUNTEER I MUST ABIDE BY ALL RULES AND

REGULATIONS. I ALSO UNDERSTAND THAT I MUST BE IN FULL UNIFORM EACH AND EVERY DAY

I AM VOLUNTEERING OR I WILL BE ASKED TO RETURN HOME AND VOLUNTEER ANOTHER DAY.

OPPORTUNITIES FOR VOLUNTEERS ARE PROVIDED WITHOUT REGARD TO RELIGION, CREED, RACE, NATIONAL ORIGIN, AGE, SEX or DISABILITY STATUS TO OTHERWISE QUALIFIED INDIVIDUALS.

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