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Applicant information

In case of emergency, please notify:

Education and experience

Previous volunteer experience:

References

Available time for volunteering (please check all time that apply)

Applicant acknowledgment: I certify that the information given by me in this application is true

and complete. I hereby authorize all individuals and organizations named or referred to in this

application to give Lakeview Regional Medical Center all information relative to my possible volunteer

assignment and work habits. I hereby release such individuals, organizations and Lakeview Regional

Medical Center from any liability for any claim, damage, which may result. I understand that I

will not be paid for time volunteering at Lakeview Regional.

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