1. First and Last Name
  2. Address, City, State, Zip Code
  3. Best phone number to reach you
  4. If number above is for work, may we contact you there?
  5. Email address
  6. Please check one:
  8. Name of your school
  9. Grade level
  10. Name of parent(s) or guardian(s)
  11. Parent(s) or guardian(s) phone number:
  13. Name and phone number of reference:
  14. Relationship to you
  15. Name and phone number of reference:
  16. Relationship to you
  18. Name of assignment
  19. Name of assignment
  20. Days of the week
  21. Time(s) available
  22. Check one answer below:
  23. If I am offered this assignment, I am able to make the commitment as stated
  24. Where do you want to volunteer at Bakersfield Memorial Hospital? (Memorial Hospital, Infusion Center at CBCC, or Ronald McDonald House)
  25. How did you learn about Memorial Hospital's Volunteer program?
  26. Do you know anyone currently volunteering or working at Memorial Hospital? If yes, who?
  27. Is volunteering a requirement (e.g., for school, church, club, court ordered, etc.)?
  28. If yes, how many hours are required and what date must they be completed by?
  29. Please list any previous volunteer experience and/or community involvement:
  30. Are you currently or have you ever been employed by Bakersfield Memorial Hospital, Dignity Health Infusion Center at CBCC, or any Dignity Health facility?
  31. If yes, where?
  32. Are you able to perform the essential functions of the volunteer assignment you are applying for, or would certain tasks need to be avoided? Please explain.
  33. Submit

Appplication from high school students MUST include two letters of recommendation from a school counselor or teacher. Youth packets with recommendation letter instructions will be emailed once application is received.

HIGH SCHOOL STUDENTS: Parental consent is required in order to volunteer. A separate form will be provided for this consent.

ADULT APPLICANTS – Please list 2 references (e.g., employer, pastor, etc. Do not list family or friends)

Which volunteer assignment(s) are you applying for?

(Wayfinder information, Nursing floor liaison, Pet Visitation Program, Youth Volunteer Program, Cuddely Progran – NICU, Infusion Center Liaison, Sewing)