Home » Giving & Volunteering » Volunteering » Student Volunteer Application Becoming a Junior Volunteer PERSONAL INFORMATIONName First Middle Last Address Street Address City State ZIP / Postal Code PhoneEmail Date of Birth MM slash DD slash YYYY CampusChoose OptionRoseauGreenbushWarroadAvailability & Site for Student Volunteer: Monday’s at Roseau Manor | 3:30PM-4:30PM Tuesday’s at Senior Living | 3:30PM-4:30PM Both Roseau Manor & Senior Living Thursdays at Greenbush Manor | 3:30PM-4:30PM Roseau County Community Events Grade (2024/2025)Choose Option5th6th7th8th9th10th11th12thOur JV program is open to students in: Roseau (6th-12th grade) Greenbush (5th-8th grade)Interests, special skills, school activities, clubs:Annual influenza vaccines are required for all employees and volunteers. Have you had a vaccination this year? Yes No If yes, date of vaccination? MM slash DD slash YYYY OTHER INFORMATIONParent/Guardian NameParent/Guardian Cell Phone NumberNote: Your child may be photographed at LifeCare Medical Center for internal and external promotion of LifeCare. Please contact us if you have questions regarding this.AUTHORIZATIONYour signature authorizes approval for your child’s participation in the student volunteer program at LifeCare Medical Center, your acknowledgement that he or she is in good health, and your consent to act in case of an emergency. You also are agreeing your child may participate in field trips between LifeCare Medical Center and Senior Living. Lastly, you agree that photographs taken of your child, may be used for internal or external marketing purposes.Volunteer SignatureParent/Guardian SignatureCAPTCHA Resources Volunteering Application
