Individual Volunteer Application

Please complete the Individual Volunteer Application below and register for a tour and orientation using this link. Once we have received your application and registration, our Director of Volunteers will reach out to you for final confirmation.

If you are human, leave this field blank.

Name: *

First

Name: *

Last

Email: *

By submitting the volunteer application you are agreeing to receive occasional electronic newsletters regarding volunteer opportunities at Christ House.

Phone Number: *

Address: *

Apt. Number (if necessary):

City: *

State: *

Postal Code: *

Date of Birth (MM/DD/YYYY): *

Church or Group Affiliation (if any):

Employer and Occupation:

Other Languages Spoken:

Would you like to receive occasional printed mailings from Christ House?

Yes

Note: Christ House will not sell, trade, or give your email or mailing address to anyone at any time.

Volunteer Opportunities (Note: Please mark your interest in the volunteer opportunities below)

Meal preparation, serving, and clean-up in the kitchen and dining room

Phone relief receptionist during evenings, weekends, and/or holidays at the nurses' station

Accompanying patients to and from medical appointments during regular business hours

OtherOther

Note: Please check the Individual Volunteer section of the website to see a brief description of the volunteer opportunities at Christ House.

Sunday Availability (Note: Please mark your availability.) *

Breakfast: 7:00AM-9:00AM

Lunch: 11:00AM-1:30PM

Dinner: 5:30-7:00PM

OtherOther

Not Available

Options listed are based on current openings. Sunday openings in the kitchen depend on rotating meal groups already scheduled.

Monday Availability (Note: Please mark your availability.) *

Breakfast: 7:00AM-9:00AM

Lunch: 11:00AM-1:30PM

Nurses' Station: 6:00PM-8:00PM

OtherOther

Not Available

Options listed are based on current openings.

Tuesday Availability (Note: Please mark your availability.) *

Breakfast: 7:00AM-9:00AM

Lunch: 11:00AM-1:30PM

Nurses' Station: 6:00PM-8:00PM

OtherOther

Not Available

Options listed are based on current openings.

Wednesday Availability (Note: Please mark your availability.) *

Breakfast: 7:00AM-9:00AM

Lunch: 11:00AM-1:30PM

Dinner: 5:30PM-7:00PM

Nurses' Station: 6:00PM-8:00PM

OtherOther

Not Available

Options listed are based on current openings.

Thursday Availability (Note: Please mark your availability.) *

Breakfast: 7:00AM-9:00AM

Lunch: 11:00AM-1:30PM

OtherOther

Not Available

Options listed are based on current openings.

Friday Availability (Note: Please mark your availability.) *

Breakfast: 7:00AM-9:00AM

Lunch: 11:00AM-1:30PM

Dinner: 5:30PM-7:00PM

OtherOther

Not Available

Options listed are based on current openings.

Saturday Availability (Note: Please mark your availability.) *

Breakfast: 7:00AM-9:00AM

Dinner: 5:30PM-7:00PM

OtherOther

Not Available

Options listed are based on current openings. Saturdays are our busiest days for volunteers. Open shifts in the kitchen depend on rotating meal groups already scheduled. General openings occur the 1st Saturday of the month for breakfast and the 3rd Saturday of the month for dinner.

Do you need special accommodations? Do you need special accommodations?

If yes, please elaborate. Please note that Christ House welcomes anyone regardless of ability, but due to the nature of our facility and staff we may be unable to accommodate all needs.

Do you need to fulfill a service requirement? Do you need to fulfill a service requirement?

If yes, please indicate how many hours, your deadline, and who is requesting this requirement. Please note that Christ House may not be able to accommodate all requests for required service hours.

How did you learn about Christ House?

Please share what draws you to serve with Christ House:

Please list a reference who can speak to your character: (Name, Address, Phone Number and E-mail)

Volunteer Policy on Confidentiality, Waiver and Release

All information related to patients, whether a part of a written record or not, is confidential and must not be transmitted to anyone other than Christ House staff who are directly participating in the patient’s care and have a need to know. In a case where there is a question about transferring information or where information is requested by an outside agency or person, the patient’s written permission is required. Exception to this rule is taken only when such disclosure is required by law.
A great deal of information related to patients is communicated daily here at Christ House. Any information that is communicated with a volunteer or overheard about a patient is confidential and should not be transmitted to anyone outside of Christ House. Mindful of the dignity and rights of each patient, volunteers should be careful of communication to and/or regarding patients in the presence of other patients and uninvolved persons.
Volunteers who assist at the nurses’ station do not have access to patient charts or medical information. If a volunteer is answering the telephone and a question comes up regarding a patient that is confidential in nature, the volunteer should check with the appropriate staff.
Volunteers who escort patients to and from medical appointments should only communicate information that was discussed with the nursing staff at Christ House.
Volunteers who assist in our kitchen and dining room may be informed of patient’s dietary needs or medical conditions as to serve them appropriately. This information and any additional information shared with you by the staff or by a patient should only be shared with the necessary staff.

i.	WAIVER AND RELEASE: I, the volunteer, release Christ House from and waive liability, claims, and demands of whatever kind, either in law or in equity, which arise from the services the volunteer provides to Christ House. I understand that this release discharges Christ House from any liability or claim that I may have against Christ House with respect to injury, illness, or property damage that may result from the services interns provide to Christ House, including from activities that may be hazardous to interns such as operation of kitchen appliances, use of kitchen instruments, use of cleaning products, travel, and exposure to various medical conditions.
ii.	PHOTOGRAPHIC RELEASE: I grant Christ House the rights to any photographs, images, video, or audio recordings that I may appear in while interning at Christ House.

By clicking below, you are acknowledging that you have read and agree to the Christ House Volunteer Waiver and Release above. *

I am aware of the requirements in maintaining confidentiality while volunteering at Christ House and I have read the waiver. I will keep all information observed and heard regarding Christ House patients confidential and I release Christ House from all liability while volunteering.

Individual Volunteer Application

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