Volunteer Application

1. Are you 18 years of age or older? YesNo

2. Do you speak a language other than English? YesNo

3. Have you ever been convicted of a crime? YesNo
If yes, for what, when and where?

4. How did you hear about the Maxcare Hospice Volunteer Program?
Current EmployerFamilyChurchSchool/CollegeVolunteerMatchFriendMaxcarehospice.comOther

5. What type of volunteer services/skills are you interested in providing?
Patient Companion VisitsOffice AssistanceBereavement ServicesSewing, CrochetingMusic TherapyArt TherapyPet TherapyMassage/ReikiVideoGraphic DesignOther

6. What are your special skills, abilities, training, experiences, hobbies and interests?

7. Preferred day(s) to volunteer:
SundayMondayTuesdayWednesdayThursdayFridaySaturday

8. Preferred time to volunteer:
MorningAfternoonEveningSpecific time (specify)

9. Have you experienced a significant loss in the past year? YesNo

10. What do you know about Hospice?

11. Please provide two (2) personal references:

12. In case of emergency, contact

I agree to Terms of Use | Privacy Policy | TCPA Consent * By submitting you agree to our Privacy Policy, Online Policy, TCPA Disclosure & Consent for SMS/Texting. Msg/data rates may apply. This consent applies even if you are on a corporate, state or national Do Not Call list. By checking this box, you expressly consent that Maxcare Hospice may call, text and email you about your inquiry. This may involve the use of automated means and prerecorded/artificial voices. This consent is not a condition to purchase any products or services. You are providing express written consent under the Telephone Consumer Protection Act (TCPA) to be contacted by Maxcare Hospice. You may revoke this consent at any time by replying 'STOP' to any text message you receive or by contacting us at (714) 844-7777.

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