Test Form

Adult Form

Address

 

Phone Numbers

( ) -

( ) -

Emergency Contacts

In emergency, please notify:

Emergency Contact 1:

( ) -

( ) -
( ) -

Emergency Contact 2:

( ) -

( ) -
( ) -

References

Please list COMPLETE MAILING ADDRESSES including ZIP CODES for 2 references. References are mailed and responses from both are necessary to complete your file. REFERENCES CANNOT BE RELATIVES

Reference 1:

Reference 2:

Have you had a significant loss in the last year?

It is required that prospective volunteers wait 12 months after experiencing a significant loss through death or divorce before volunteering with patients. You many still volunteer in other roles that do not have patient contact. Please answer yes or no and let us know the date of the loss.

It is required that prospective volunteers wait 12 months after experiencing a significant loss through death or divorce before volunteering with patients. You many still volunteer in other roles that do not have patient contact. Please answer yes or no and let us know the date of the loss.

Veteran Status

Please check below if you are a veteran

Please check if you are a veteran.

Type of Volunteering

Please let us know what type of volunteering you are interested in doing: Other support would include fundraising, community outreach, marketing/recruiting, etc.

Please let us know what type of volunteering you are interested in doing: Other support would include fundraising, community outreach, marketing/recruiting, etc.

I Agree

Hospice of the Western Reserve and the volunteer applicant acknowledge that the training classes are a time of exploration and attendance does not guarantee volunteer placement.

Hospice of the Western Reserve and the volunteer applicant acknowledge that the training classes are a time of exploration and attendance does not guarantee volunteer placement.


Teen Form

Address

 

Demographic Information (Optional)

Please help us to maintain our database for reporting purposes.

Today

Phone Numbers

( ) -

( ) -

Emergency Contacts

In emergency, please notify:

Emergency Contact 1:

( ) -

( ) -
( ) -

Emergency Contact 2:

( ) -

( ) -
( ) -

Emergency Contact 3:

( ) -

( ) -
( ) -

Physician

( ) -

Dentist

( ) -

Preferred Hospital

( ) -

High School

School Contact

( ) -

Have you had a significant loss in the last year?

It is required that prospective volunteers wait 12 months after experiencing a significant loss through death or divorce before volunteering with patients. You many still volunteer in other roles that do not have patient contact. Please answer yes or no and let us know the date of the loss.

It is required that prospective volunteers wait 12 months after experiencing a significant loss through death or divorce before volunteering with patients. You many still volunteer in other roles that do not have patient contact. Please answer yes or no and let us know the date of the loss.

Type of Volunteering

Please let us know what type of volunteering you are interested in doing: Other support would include fundraising, community outreach, marketing/recruiting, etc.

Please let us know what type of volunteering you are interested in doing: Other support would include fundraising, community outreach, marketing/recruiting, etc.

I Agree

Hospice of the Western Reserve and the volunteer applicant acknowledge that the training classes are a time of exploration and attendance does not guarantee volunteer placement.

Hospice of the Western Reserve and the volunteer applicant acknowledge that the training classes are a time of exploration and attendance does not guarantee volunteer placement.


 

We Can Help

Speak with the referral team by contacting us seven days a week, 24 hours a day. Any first visit and admission can be made the first day.

Northern Ohio's Hospice of Choice

More than 1,000 Hospice of the Western Reserve employees and 3,000 volunteers live and work side-by-side in the same neighborhoods with our patients and families. We are privileged to have cared for more than 100,000 Northern Ohioans since our inception.