Noah’s Children Volunteer Form.

Thank you for your interest in becoming a volunteer at Noah’s Children.

Please take a few moments to complete the following form. If you have any questions regarding this application, please contact us at (804) 287-7686 or send us an email (mailto: fran_givens@bshsi.org)


Personal Information:
Date
First Name
Last Name
Occupation
Address
Apt.
City
State/Zip
E-mail
Home Phone
Work Phone
Language Proficiency (other than English)
Date of Birth
Please check any of the following tasks that you are interested in performing as a Noah’s Children volunteer:
General Volunteer Tasks:
Clerical (typing/filing/mailings)
Answering Phones
Event Planning
Staffing (Informational/Fundraising Booth)
Speakers Bureau
Child Care (e.g., during support groups)
Grant Writing

Patient-Family Volunteer Tasks:
Household Tasks (shopping/cleaning)
Handyman Tasks (household repairs/lawn maintenance)
Drive patients/family members to appointments
Respite Care for Pediatric Patients
Providing support to siblings or children of Noah’s patients
Social Work
Hospital Visitation
Pastoral Care /Bereavment
Other (please specify)
List any special skills, training or certifications that you possess that would enable you to perform these tasks:

How I heard about Noah’s Children:
Newspaper Ad	Civic Group
Agency Brochure	Physician
Website	Speakers Bureau
Health Fair	Information Booth
Word of Mouth	Other
References – Give name and telephone number of two (2) references who are not related to you and are not previous employers:
1. Name
Address (City/State/Zip)
Phone Number
Occupation
Relationship
2. Name
Address (City/State/Zip)
Phone Number
Occupation
Relationship
Check the space(s) below that best describes your willingness to volunteer:
I would like to commit a few hours each week to work in the office.
I would like to work on a specific project, with a definite beginning and end.
I would like to coordinate/manage the work of others.
I would like to serve on a committee that meets regularly.
I would like to participate in patient/family care.
I am available in the day time.
I am available at night time.

“The art of caring for a child with a life-threatening illness means not just adding days to life, but adding life to that child’s day.”

Dr. Bob Archuleta, Founder and Medical Director of Noah’s Children