Volunteer Services Application

"*" indicates required fields

Personal Information

Name:*
Address:*
Birthday:

Student Section Only

Person to notify in case of emergency

Name:*
Address:*

Volunteer Preferences

Where do you wish to volunteer?
LCHC Crafters Skills
LCHC Crafters Interests
Health Care Skills:
Other Skills:
I would be willing to:

I understand and agree that submitting this application does not automatically enlist me as a volunteer at Lucas County Health Center. I understand and agree there may be policies I must agree to and qualifications I must meet before accepted. I also understand that there is no employer-employee relationship relative to my volunteerism and I will not receive monetary compensation in exchange.
Signature*
Parent/Guardian Signature
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