Kate's Kart, Inc.

Thank you for your interest in volunteering! You may either complete the online application below,

or download the application in Word or PDF format to print and mail.

PDF - Click here to download in PDF Format*

Word - Click here to download in Word Format

Name:

Address:

City/State/Zip:

Telephone Number:

Email Address:

Birthday:

School (if under age 18):

How did you hear about kate's Kart?

Do you have any previous volunteer experience? If so, please tell us about it:

Why do you want to volunteer for Kate's Kart?

Do you know anyone who currently volunteers for Kate's Kart?

Do you have any experience in a hospital setting? Do you have any apprehensions about being in a hospital?

If in school, what other extracurricular activities do you participate in?

At which hospital(s) would you like to volunteer? (Please check all that apply.)

Dupont Hospital
Parkview Regional Medical Center
Lutheran Hospital
Other Hospital; Please specify:

I want to volunteer in another way. Please explain:

What days and/or times are you available to volunteer?

Do you have any personal or professional references you could provide?

Is there anything else you would like to tell us?

Please initial in each box below that you understand and agree to each statement:

	I agree to attend an initial orientation session required by the hospitals, including paperwork, a background check and TB testing.
	I agree to renew my TB test annually and keep my files active and complete at each hospital that I am a volunteer.
	I understand that pushing the kart requires a degree of physical work. (I could be on my feet for up to 2 hours. I need to be able to bend over to pick out books, and push a kart throughout the halls of the hospital.)
	I agree to adhere to the dress code (which will be explained by each hospital).
	I agree to communicate regularly with my Kate's Kart volunteer scheduler in regards to my personal volunteer schedule.
	I agree to fulfill my assigned date(s) and will take it upon myself to find a replacement or let my Kate's Kart volunteer scheduler know (with sufficient notice) if I am unable to fulfill my assignment.
	I understand that not showing up for an assigned date without notice may result in my not being scheduled in future months.
	I agree to check the Kate's Kart website regularly for updates to the volunteer schedule.
	I agree to uphold the mission and integrity of Kate's Kart and speak positively about the organization at all times.
	I agree to smile, have fun and be encouraging to sick and injured children and their families, and to be respectful of their privacy.
Signature (By typing your name in the box below, you are signing this application):