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Vantage Hospice & Palliative Care
Hospice Care
Palliative Care
About
About Us
Volunteer
Employment Opportunities
Honor Your Extraordinary Nurse
We Honor Veterans
Blog
Contact Us
FAQ
Leave a Review
Vantage Hospice & Palliative Care
Hospice Care
Palliative Care
About
About Us
Volunteer
Employment Opportunities
Honor Your Extraordinary Nurse
We Honor Veterans
Blog
Contact Us
FAQ
Leave a Review
Vantage Hospice Volunteer Application
Name
Email
Present Address
-
Are you 18 years old or older?
Yes
No
Date of Birth
Occupation
Briefly describe the type of work you do:
Home Phone
Cell Phone
Work Phone
Total Number of Hours Per Week You Can Volunteer
Availability for Volunteering
Daytime
Evenings
Weekends
Highest Level of Education Received:
Teen Volunteer
Highschool Diploma
2 Yr College
4 Yr College
Post-Graduate
Choose from the dropdown
Other Languages Spoken
Do you know anyone working for Vantage Hospice?
How did you hear about us?
Why do you wish to be involved with Hospice?
What organization or clubs do you belong to?
Have you had experience with the terminally ill?
Has someone close to you died within the past year?
How do you feel about going into a patient's home?
Do you currently have the COVID-19 vaccination? If not, would you be willing to get vaccinated?
What are your hobbies?
Do you have available transportation for your volunteer work?
Yes
No
Do you have a valid Texas Driver's License?
Yes
No
Do you have automobile liability insurance?
Yes
No
Have you been convicted of a felony?
Yes
No
Are you presently charged with any violation of the law, other than a traffic violation?
Yes
No
List any experiences you've had which you believe would be helpful in Hospice Volunteering:
List any experiences you've had which you believe would be helpful in Hospice Volunteering:
Indirect: Areas of Interest (check all that apply)
Office Assistance
Mass Mailings
Artwork
Sewing/Crafts/Gifts
Photography
Computer hardware/networks
Gardening
Pen Pal
Other
List 2 Personal References:
Name of Emergency Contact:
Relationship to Emergency Contact
Phone Number of Emergency Contact:
Physician Name:
Physician Phone:
Declaration:
I hereby certify that the statements made on this application are true and correct to the best of my knowledge.
Typing your name in the text box below serves an electronic signature certifying the statement above:
Send
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