Volunteer Signup Form

Please note: Unfortunately, we cannot accommodate people attempting to fulfill court-ordered community service requirements or persons under 18 years of age.

All fields with asterisk (*) are required.
Enter your date of birth in this format: mm/dd/yyyy
Over 18 years of Age? *

Emergency Contact Information

Please list someone we can contact in case of an emergency.

Work Experience

(Important to complete for successful placement)

Please provide two personal references

(not a relative) who has known you for at least one year.

Please check days and times when you are available

Mornings 8am-12pm

Afternoons 12pm-4pm

Evenings 4pm-8pm

All applicants 18 years and older will undergo a background check.
I agree to comply with all policies and procedures and to support the mission of Good Samaritan Medical Center and to serve without remuneration for my services
Please enter date in this format: mm/dd/yyyy