Teen Volunteer

*Highlighted fields are required

* First Name

Middle Initial

* Last Name

* Date of Birth (mm/dd/yyyy)

Address Information

* Home Address

Apt.#/Suite

* City

* State

* Zip

* E-mail (This e-mail address will be used for all ongoing correspondence).

Phone (Home)

Phone (Mobile)

Emergency Contact

* Name

* Relationship

* City/State/Postal

Phone (Home)

Phone (Mobile)

Connecticut Children's Employee Referral Information

Do you have relatives employed at Connecticut Children's? If YES, please complete name, relationship, and department information below.

Name of Person who Referred you:

Relationship

Department

Comments

Prior Service History

Have you or any family member ever received service at Connecticut Children's or any of their satellite locations?

If YES, date of most recent visit

Employment Information

Are you presently employed?

If yes, what kind of work do you do?

Availability

Volunteer shifts are typically 3 hours long.
Morning shifts are scheduled between 9:00am and 1:00pm
Afternoon shifts are scheduled between 1:00pm and 6:00pm
Evening shifts are scheduled 4:00pm and 8:00pm
(Choose all that apply)

Mon - Morning

Mon - Afternoon

Mon - Evening

Tue - Morning

Tue - Afternoon

Tue - Evening

Wed - Morning

Wed - Afternoon

Wed - Evening

Thu - Morning

Thu - Afternoon

Thu - Evening

Fri - Morning

Fri - Afternoon

Fri - Evening

Sat - Morning

Sat - Afternoon

Sat - Evening

Sun - Morning

Sun - Afternoon

Sun - Evening

Tell Us About You

* Why do you want to volunteer at Connecticut Children's?

* What qualities, skills and knowledge do you have that would make you a great volunteer?

* Describe what you hope to gain through your volunteer experience at Connecticut Children's.

* What is your experience with working with a variety of people?

* What are your hobbies and interests?

Other organizations to which you have provided volunteer services:

Please provide the name and e-mail address of two people who know you well and whom we may contact for references. They should not be family members. family members.

Name

Relationship

E-Mail

Name

Relationship

E-Mail

1st Dose COVID-19

2nd Dose COVID-19

Booster

2nd Booster

COVID-19 Documentation

I understand that any volunteer joining Connecticut Children's during flu season will be required to show documentation of a current influenza vaccination, and an annual vaccination is mandatory for continued participation in the program.

Additional Information

The documentation listed as required must be submitted in order for your application to be considered complete.

If accepted into the program, would you be willing to submit to a criminal background check?

* Current Photo of Applicant

* Parental Consent

* Consent for Treatment

By submitting my application, I understand that Connecticut Children's will consider me for a volunteer position on the basis of the information I have furnished on this application form, and that any false, misleading or incomplete statements made by me, or any omission of material fact shall prevent my volunteering or shall be cause for immediate dismissal from my volunteer assignment.

I understand that the staff of the Volunteer Services Department will be calling the references I have listed on this application, and conducting a background check on me prior to being placed. As part of the volunteer application process, and at any time during my volunteer placement, I authorize Connecticut Children's or any of its affiliates to obtain the record of any conviction for commission of a felony.

[ clear ]

Please provide a digital signature and click Submit.