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Get Waco Junior Volunteers Providence Form

Application Date Providence Healthcare Network 6901 Medical Parkway Waco TX 76712 Volunteer Services 254 751-4104 JUNIOR VOLUNTEER APPLICATION You must be 15 years of age by June 1 2013 or entering 10th grade in the fall of 2013 to apply as a Junior Volunteer at Providence Health Center. You also must attend a mandatory orientation on Monday June 10 2013 10 00 a.m. to 1 00 p.m. at PLEASE PRINT Last Name First Name Nickname Home Phone Address Date of Birth Social Security Number SSN MI Cell Phone City State Zip Sex M or F Age Name of School Grade You Will Enter in Fall 2013 Have you volunteered before If yes where Hours each week you want to volunteer min. 4 Name of Parents Mother s Business name and address Work Phone In case of emergency contact Phone over please APPLICANT AND PARENT PLEDGE I pledge to follow the rules and regulations of the Junior Volunteer program at Providence Health Center as presented by the Director of Volunteers and voted on by the Providence Volunteer Board. Applicant s Signature Parent s Signature NOTE You must be in uniform at Orientation Registration Fee 35. Application Date Providence Healthcare Network 6901 Medical Parkway Waco TX 76712 Volunteer Services 254 751-4104 JUNIOR VOLUNTEER APPLICATION You must be 15 years of age by June 1 2013 or entering 10th grade in the fall of 2013 to apply as a Junior Volunteer at Providence Health Center. You also must attend a mandatory orientation on Monday June 10 2013 10 00 a*m* to 1 00 p*m* at PLEASE PRINT Last Name First Name Nickname Home Phone Address Date of Birth Social Security Number SSN MI Cell Phone City State Zip Sex M or F Age Name of School Grade You Will Enter in Fall 2013 Have you volunteered before If yes where Hours each week you want to volunteer min* 4 Name of Parents Mother s Business name and address Work Phone In case of emergency contact Phone over please APPLICANT AND PARENT PLEDGE I pledge to follow the rules and regulations of the Junior Volunteer program at Providence Health Center as presented by the Director of Volunteers and voted on by the Providence Volunteer Board. Applicant s Signature Parent s Signature NOTE You must be in uniform at Orientation Registration Fee 35. 00 includes uniform shirt and ID badge Cash check MasterCard VISA and Discover cards accepted* Make checks payable to Providence Volunteer Services. You also must attend a mandatory orientation on Monday June 10 2013 10 00 a*m* to 1 00 p*m* at PLEASE PRINT Last Name First Name Nickname Home Phone Address Date of Birth Social Security Number SSN MI Cell Phone City State Zip Sex M or F Age Name of School Grade You Will Enter in Fall 2013 Have you volunteered before If yes where Hours each week you want to volunteer min* 4 Name of Parents Mother s Business name and address Work Phone In case of emergency contact Phone over please APPLICANT AND PARENT PLEDGE I pledge to follow the rules and regulations of the Junior Volunteer program at Providence Health Center as presented by the Director of Volunteers and voted on by the Providence Volunteer Board. Applicant s Signature Parent s Signature NOTE You must be in uniform at Orientation Registration Fee 35.

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