Adult & Child Life Volunteer Application

Personal
First Name
Middle Initial
Last Name
Date Of Birth * / MM / DD YYYY
You must be 18 years old or older to submit an application. If you are not yet 18 years old your application cannot be considered.
Gender Male Female
Address
Street Address
City
State
Zip
Email

You must enter a valid e-mail address to receive a confirmation of your application.
Contacts
Home Phone - (###) - ### ####
Cell Phone - (###) - ### ####
Work Phone - (###) - ### ####
Emergency Contact Name
Emergency Contact Number - (###) - ### ####
Emergency Contact Relationship
References
First Reference Name
First Reference Address
First Reference Phone - (###) - ### ####
Second Reference Name
Second Reference Address
Second Reference Phone - (###) - ### ####
Volunteer/Interest Information
Previous Volunteer Experience:
Skills/Interests/Hobbies:
Are you a College Student? No Yes
College Credit Hours No Yes
If yes, how many hours must you complete?
Areas of Interest: (Check all that apply) Children's Hospital Clerical Work Emergency Room Gift Shop Patient Contact Reception Tours Other
Days Available: (Check all that apply) Sunday Monday Tuesday Wednesday Thursday Friday Saturday
Times Available: (Check all that apply) Morning Afternoon Evening
Preferred Orientation
*

Please select the date on which you'd like to attend orientation.
WE ARE NOT ACCEPTING CHILD LIFE APPLICATIONS AT THIS TIME
Special Child Life Volunteer Application Section - In addition to the above please complete the following sections ONLY if you are applying to volunteer with our Child Life program.
Educational Background:
Experience with children:
How did you learn about Child Life at this hospital?:
Please describe any past experiences you have had with hospitals (as a patient, parent, visitor, volunteer, etc.):
How have these experiences affected your attitude toward hospitals?:
Why would you like to work with hospitalized children and/or adolescents?:
What do you hope to gain from this experience?:
Have you thought about situations that you might see and experience in our hospital? Please describe:
How would you feel about working with a child who was hospitalized as a result of a traumatic injury or one who has undergone treatment unsuccessfully for life threatening illness?:
Is there a particular age group that you would prefer to work with (infants, toddlers, preschoolers, school-age or adolescents):
Is there anything that you would like to share with us about yourself or about your interest in volunteering with pediatric patients at Penn State Children's Hospital?:
Note: If you do not receive your e-mail confirmation within 1-2 minutes please check your spam/junk mail folder.

Adult & Child Life Volunteer Application

Personal

Address

Contacts

References

Volunteer/Interest Information

Preferred Orientation

WE ARE NOT ACCEPTING CHILD LIFE APPLICATIONS AT THIS TIME

Special Child Life Volunteer Application Section - In addition to the above please complete the following sections ONLY if you are applying to volunteer with our Child Life program.

Note: If you do not receive your e-mail confirmation within 1-2 minutes please check your spam/junk mail folder.