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Student Volunteer Application

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Student Volunteer Application

become a junior volunteer! (3)

PERSONAL INFORMATION

Name
MM slash DD slash YYYY
Availability & Site for Student Volunteer:
Our JV program is open to students in: Roseau (6th-12th grade) Greenbush (5th-8th grade)
Annual influenza vaccines are required for all employees and volunteers. Have you had a vaccination this year?
MM slash DD slash YYYY

OTHER INFORMATION

Note: 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.

AUTHORIZATION

Your 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.
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