Student Volunteer Registration - Hospice Volunteers of Hancock County

HVHC Student Volunteer Form

"*" indicates required fields

Name*

First Last

Phone*

Address

Street Address City State / Province / Region ZIP / Postal Code

Email*

School and Grade*

Parent/Guardian Information

I understand that students under 18 must have a parent/guardian complete the required permission, liability waivers and photo release before participating.*

Yes

Name of Parent/Guardian*

First Last

Relationship to Student*

Phone*

Email*

Safety, Dietary restrictions/allergies & Other Considerations

Is there anything HVHC should know to help you safely participate in this outdoor service project?

Student Agreement*

I understand that I will be working with Hospice Volunteers of Hancock County and I will be visiting the home of a HVHC patient. I agree to respect the privacy and dignity of patients and families and to keep all personal and confidential information private.

Yes

I agree to follow all safety instructions and the directions of HVHC staff, adult volunteers, and project leaders.*

Yes

Signature*

Date

For students under 18: Parent/Guardian forms will be sent to the email address provided above and must be complete before participation. If you are over 18, additional forms will be sent to your email address.