Johns Hopkins All Children's Hospital Volunteer Access Page

Adults interested in volunteering must be at least 18 years old and completed high school. Teen volunteers must be at least 15 years of age and have completed the ninth grade.

Pet Therapy Escort Volunteer Application

Pet Therapy Escort Volunteer Application
* Indicates Required Fields to Submit Application
Your Information
First Name*
MI
Last Name*
Home Address Line 1*
Home Address Line 2
City*
State
Zip Code*
If less than five (5) years, please list your former state(s) of residence
Home Phone
Cell Phone
E-mail Address*
DOB
Gender
Teen - Must have completed the ninth grade.
Volunteer Type*
Adult - 18+ year of age and completed highschool
Emergency Contact Information
Contact Full Name
Relationship (e.g. husband, wife, father, mother)
Address
City
State
Zip Code
Home Phone
Cell Phone
Work Phone
E-mail
Work Information
Work Name
Address
City
State
Zip Code
Work phone
School Information
I am currently a student
Expected Graduation
High Schools
Colleges
If your school is not listed, please do so here:
Community Involvement
Do you belong to any community or civic organizations?
If YES, please specify:
Are you currently a volunteer, or have done volunteer work in the past?
If YES, please specify:
Pet Therapy
Are you interested in bringing a certified dog to do pet therapy at All Children's Hospital?
If YES, please exit this application and apply to the Pet Therapy Owner Volunteer Application.
Are you interested in being an escort for the pet therapy team who visit the children at All Children's Hospital?
Your Skills
Describe your experience working with animals, especially dogs:
Have you spent time in hospitals or medical environments?
If YES, how comfortable are you in these environments?
How flexible is your time?
If you have any other skills that need mention and not listed above, please specify:
Volunteering
Please select how you heard about volunteering at All Children's Hospital*
Referred By:
Why would you like to volunteer?*
Please explain your desire for volunteering futher*:
Disclose any physical limitations which may require accommodations to volunteer
If you have ever been convicted of a felony, misdemeanor, or other criminal offenses and/or any arrests or pending criminal proceedings currently pending against you, please explain here:

Statement of Understanding And Agreement

All Children's Hospital is a drug free campus. I understand that by applying for a volunteer position, if accepted, I may be subject to a drug screening.

All Children's Hospital requires volunteers to commit to volunteering a minimum of 60 hours over a six month period (generally one day a week for two to four hours). This requirement must be fulfilled in order to receive any correspondence (i.e. Hours, Letters of recommendation, etc...) from the Volunteer Resources Office.

I certify that the information given by me in this appilcation is true in all respects and that I have not made any willful omissions. I agree to abide by all present and subsequent rules and regulations of All Children's Hospital and understand such rules and regulations may be modified at any time, such deemed necessary by All Children's Hospital.

I understand that if accepted into the volunteer program at All Children's Hospital that I am required to have immunity to Chickenpox, Measles, Mumps, and Rubella. To verify immunity, I must provide the following information to All Children's Hospital Employee Health:
     Varivax (Chicken Pox)
           Written documentation with 2 doses of vaccine,
           Laboratory evidence of immunity,
           Diagnosis of history of varicella disease by a health-care provider, or diagnosis of history of herpes zoster by a health-care provider.

     MMR (Measles, Mumps, Rubella
          Born BEFORE 1957: NO DOCUMENTATION NECESSARY
          Born in 1957 or later:
               Proof of immunity includes one of the following:
                    - Two vaccines after 12 months of age.
                                         OR
                    - Laboratory evidence of immunity for Measles (Rubeola), Mumps, and Rubella.

     Tetanus/Pertussis and Diptheria(Tdap)
           If you have never had a Tdap immunization you should receive a single dose of Tdap from your own doctor before you begin to volunteer.

     Tuberculosis
           A TB screening will be provided by the hospital if your application is accepted.

Immunization/immunity records may be acquired from either your doctor, school, university, or the Public Health Department.

Furthermore, I understand that if selected to volunteer, disclosure of confidential information concerning the hopital or a patient may cause immediate dismissal. By submitting this application, I am agreeing to these requirements as set by the All Children's Hospital Volunteer Resources Office.

*I agree to the statement of understanding and agreement. (if you do not agree, your application will NOT be processed)