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You will be allowed to volunteer three days each week. Please check preferred days:
Please check preferred hours:

I hereby apply for volunteer service with John Randolph Medical Center. I understand and agree to comply with the requirements and regulations of the Medical Center and to consider all privileged information concerning the hospital, its patients and staff strictly confidential. I will take all criticisms and problems to the Director of Patient Support Services. If it is felt in the best interest of the Medical Center, I can be relieved of all of my volunteer responsibilities.

I give permission to John Randolph Medical Center to use my picture or likeness, which may be taken at the hospital, activity or event for use in advertising, promotional materials, website display, posters or publications.


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