Dear Prospective Volunteer
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- Have you ever been employed by the AtlantiCare Health System No Yes
- How did you hear about volunteering with AtlantiCare
- How would you like to volunteer with AtlantiCare (Volunteer opportunities are based on department needs and volunteer skills. Please check all areas of interest.)
- Is your volunteering a short term commitment
- ARE YOU A VETERAN No
- Please list any hobbies or specialized talents you want to share (e.g. crafts, gardening, filing/clerical
Emergency Contact: Name: ____________________________________________ Relationship: __________________________ Address: ________________________________________________________________________________ City:__________________________________ State:________________ Zip Code:____________________ Home Phone: ______________________________ Cell Phone: ___________________________________ Business Phone:____________________________ Employer:______________________________________ ► Have you ever been employed by the AtlantiCare Health System? No Yes If yes, when and which department? _____________________________________________________ Do you have any relatives who are employed or volunteer at AtlantiCare? No Yes, If yes, please list the name of the person, relationship to you, and the department they work in.
How did you hear about volunteering with AtlantiCare?_________________________________________ Please tell us why you would like to be an AtlantiCare Volunteer: (required) ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ 
How would you like to volunteer with AtlantiCare? (Volunteer opportunities are based on department needs and volunteer skills. Please check all areas of interest.) Interacting with patients (e.g. visiting patient rooms, sitting with patients to offer companionship, hospitality cart) Interacting with the public (e.g. information desk, hospital greeter/guide, registration, dietary, accompanying musicians/pet visits throughout the hospital) Logistics (e.g. restocking, rotating inventory, delivering supplies) Clerical help (e.g. filing, computer data entry, assembling information packets, phone support, laminating, mailings) Creative Arts and Healing Program (e.g. musicians, licensed pet therapy, etc. to visit patients or perform in lobbies) Pastoral – provides emotional and spiritual support to patients Growing Green, AtlantiCare’s Community Gardening Initiative: Volunteers help to sustain community gardens sponsored by AtlantiCare. Volunteers participate in planting activities, programming opportunities, and general maintenance of gardens. Volunteers to work as a team, but also opportunity for independent gardening. A green thumb is not required! Auxiliary (fundraising/community representatives of the hospital, $15 annual dues) Gift Shop sales (e.g. pricing of items, stocking shelves, sales, cashier) Heart Heroes – participate in fund raising activities to place automated external defibrillators in our community through a matching funds program Bumper “T” Caring Clowns (Interested volunteers complete a comprehensive clown training course offered by Bumper “T” Caring Clowns on the art of gentle humor. They use therapeutic clowning as a powerful tool to promote the healing process. From the moment they enter a hospital, the Caring Clowns consider themselves a positive, healing force. They pride themselves on being masters in the art of “reading” a room, listening, and using gentle humor to make true connections with the people who need them. www.bumpertcaringclowns.org for more information. Hospice ** helping patients and their families who are at end of life, either directly with the patients/families, or helping in the hospice office. PLEASE COMPLETE THE HOSPICE QUESTIONNAIRE form of the application if you may be interested in this area of volunteering. It is mandatory to attend a one- time specialized training which is held at the AtlantiCare Hospice and Palliative office in Egg Harbor Township. The training is held on a Saturday from 8:00 a.m. to approximately 4:30 p.m. Other interests for volunteering? Please explain:______________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ Is your volunteering a short term commitment? No Unknown at this time Yes – If yes, please explain:__________________________________________________________________________________ ________________________________________________________________________________________ ARE YOU A VETERAN? No YES – If yes, thank you for your service! Please list branch of military: Branch:__________________________________________________________ DO YOU SPEAK ANOTHER LANGUAGE? No Yes – If yes, what languages?_________________ ________________________________________________________________________________________ Please list any hobbies or specialized talents you want to share (e.g. crafts, gardening, filing/clerical
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