Volunteers

We are in the process of updating our volunteer paperwork. If you are interested in volunteering, please respond with the following information to Nancy.Meydell@allina.com

CONTACT INFORMATION:
First Name:
Last Name:
Nickname:
Street:
City:
State:
Zip:
County:
Phone:
Email:

DEMOGRAPHICS:
Date of Birth
Gender
How did you hear about us?

ASSIGNMENT: (select all that apply)
Handiham Reader
Handiham Equipment Specialist
Handiham Mentor/Elmer
Handiham Camp Volunteer
Handiham Special Projects

EMERGENCY CONTACT:
First Name:
Last Name:
Street:
City:
State:
Zip:
County:
Phone:
Relationship:

EMPLOYER:
Company
City:
State:
Zip:
County:

BACKGROUND STUDY:
Have you ever been convicted of a crime? If yes, please specify.

REFERENCES:
Please provide the name, relationship and contact information for TWO references. (No family members please) Your references will be contacted.

CODE OF ETHICS:
As a volunteer, I realize that I am subject to a code of ethics similar to that which binds the professional in the field in which I work. I, like them, assume certain responsibilities and expect to account for what I do in terms of what is expected of me. I understand that any information that is disclosed to me while assisting Allina Health is confidential. I interpret “volunteer” to mean that I have agreed to work without compensation in money. If and when I’m accepted as a volunteer worker, I expect to do my work according to the standards set forth in the Volunteer Policies and Procedures.

SIGNATURE:
Thank you for completing the application. Please sign below to verify you agree with the code of ethics and all the information provided is accurate. (If you are a minor, please have your parent/guardian sign as well.)

Thank you,

Lucinda Moody, AB8WF
Lucinda.Moody@allina.com