Volunteer Application

Name *
Birthday *
Address *
Phone *
Please provide us with the best number to contact you at
Emergency Contact *
Emergency Contact
Emergency Contact Number *
Emergency Contact Number
High School Attended, College Attended, Other Special Training
Please provide the names and contact information of at least 2 non-family member references.
Areas of Interest *
Please select the areas you think you'd like to volunteer.
Do you read/write/speak another language? If so, what languages?
Please describe briefly:
I hereby certify that the statements made on this form are true and correct to the best of my knowledge. I understand that by submitting I authorize this information to be used by the staff of Richmond County Hospice to verify my employment, character, and records to determine my suitability to volunteer. By typing my FULL NAME below and selecting SUBMIT, I agree to these statements and am ready to volunteer with Richmond County Hospice.