Volunteer Agreement

1. I shall keep confidential all information that I obtain regarding patients, staff, and volunteers.

2. I shall submit to any immunizations that may be a necessary part of my volunteer service.

3. I shall be punctual and conscientious, conduct myself with dignity, courtesy and consideration of others, and endeavor to make my work professional in quality.

4. I agree to resolve any problems that may arise with the Volunteer Coordinator.

5. I shall make my best effort to fulfill my commitment to the Clinic by volunteering at least four hours per month and by completing all assignments that I accept.

6. I shall at all times uphold the philosophy and standards of the clinic.

7. I understand that the Volunteer Coordinator reserves the right to terminate my volunteer status as a result of:

a) Failure to comply with clinic policies, rules, and regulations.

b) Absences without prior notification.

c) Unsatisfactory attitude, work, or appearance.

d) Any other circumstances, which in the judgment of the Clinic staff would make my continued service as a volunteer contrary to the best interests of the Clinic.

I have read each of the above conditions and agree to be bound by them. I certify that the information I have given is complete, true and correct to the best of my knowledge and belief. I further affirm that I have not knowingly withheld any facts or circumstances in completing this application.

PLEASE NOTE:

By entering your Full Name in the "Signature" section below, you warrant the truthfulness of the information provided in this application.

Volunteer Application