Volunteer Application

Volunteer Application
Personal Information
Volunteer Requirements:
- Be at least 18 years of age
- Agree to a criminal background check
- Agree to volunteer at least twice a month, for a minimum of 1 year
- Interview with the Aurora on Wheels Coordinator of In-Hospital Programs
- Adhere to Aurora on Wheels and hospital policies and procedures
- Adhere to CHOA's Standards of Conduct
- Be willing to receive an annual flu and COVID-19 vaccination
- Be willing to receive an annual tuberculosis (TB) screening (via bloodtest)
- Provide proof of immunity to measles, mumps and rubella (MMR), chickenpox, and tetanus, diphtheria and pertussis (Tdap).
- Follow through with any additional training Aurora on Wheels and the hospital volunteer department may require.
VOLUNTEERS MUST HAVE ALL REQUIRED VACCINES UP TO DATE. ANNUALLY, ALL VOLUNTEERS MUST GET THE FLU SHOT AND TB/PPD TEST.
Date of Application*

MonthDayYear
Date
Full Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Preferred form of communication*

PhoneEmailText Message
E-mail*
Cell Phone Number*

Area CodePhone Number
Work Phone Number*

Area CodePhone Number
Occupation*
Employer or School Name*
What is your shirt size?*

XSSMLXL
Languages Spoken*
Training or Certifications pertinent to child care*
Do you have any physical limitations? If so, please specify:*
Have you ever been convicted of a felony or misdemeanor other than minor traffic offenses? If so, please explain. *
Emergency Contact Information
Emergency Contact Name*

First NameLast Name
Emergency Contact Relationship*
Spouse, Parent, Sibling etc.
Emergency Contact Primary Telephone*

Area CodePhone Number
Emergency Contact Secondary Telephone*

Area CodePhone Number
Emergency Contact Email*
example@example.com
Previous Hospital or Community Volunteer Experience
#1 Where*
#1 When*
#1 Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
#1 Supervisor*
#1 Phone Number*

Area CodePhone Number
#1 Email*
example@example.com
#1 Your Role*
#2 Where
#2 When
#2 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
#2 Supervisor
#2 Phone Number

Area CodePhone Number
#2 Email
example@example.com
#2 Your Role
Background Questions
What type of childcare experience, if any, do you have? (If babysitting/nanny, please indicate age of child/children and name of parent with contact information)*
Do you have any experience working/volunteering with children with cancer/chronic illness/special needs? Please describe. *
Why do you want to volunteer in a hospital environment?*
Please specify what personal skills/characteristics you will bring to Aurora on Wheels to fulfill the special needs of the children: *
How did you hear about Aurora on Wheels?*
Which of the following hospitals are you interested in volunteering? Please check all that apply.*

Children's Healthcare of Atlanta (CHOA) - EglestonChildren's Healthcare of Atlanta (CHOA) - Scottish Rite
Personal References
#1 Personal Reference - Name

First NameLast Name
#1 Personal Reference - Phone Number

Area CodePhone Number
#1 Personal Reference - Relationship
#1 Personal Reference - Length of time known
#2 Personal Reference - Name

First NameLast Name
#2 Personal Reference - Phone Number

Area CodePhone Number
#2 Personal Reference - Relationship
#2 Personal Reference - Length of time known
Professional References
#1 Professional Reference - Name

First NameLast Name
# 1 Professional Reference - Phone Number

Area CodePhone Number
#1 Professional Reference - Company/Position
#1 Professional Reference - Length of time known
#2 Professional Reference - Name

First NameLast Name
#2 Professional Reference - Phone

Area CodePhone Number
#2 Professional Reference - Company/Position
#2 Professional Reference - Length of time known
Submission Signature
Sign Name*

Clear
Date*

MonthDayYear
Date
Authorization to Check Criminal Records
I, {fullName3}, hereby authorize the Sunrise Association and/or Aurora on Wheels to obtain information pertaining to any charges I may have for federal and state criminal law violations. This information will include convictions committed upon minors and adults, and will be gathered from any law enforcement agency of this state or any other state or federal government to the full extent permitted by law.

I understand that such access is for the purpose of considering my application as a volunteer and that I expressly DO NOT authorize the Association, its directors, officers, employees, or other volunteers to disseminate this information in any way to any other individual, group, agency, organization or corporation.
Signed*

Clear
Date of Signing*

MonthDayYear
Date
Should be Empty:

Volunteer Application

Personal Information

Emergency Contact Information

Previous Hospital or Community Volunteer Experience

Background Questions

Personal References

Professional References

Submission Signature

Authorization to Check Criminal Records