I hereby certify that all the above statements on this application are true and correct to the best of my knowledge. I understand that, by submitting this application I authorize Family Hospice to make any inquiries to determine my ability for volunteer services, with the understanding that any misrepresentation I make will be just and due cause for non-acceptance or dismissal as a volunteer. I confirm that I have read the volunteer Code of Ethics and agree to abide by its regulations. If qualified for volunteer service, I agree to abide by the rules and regulations of Family Hospice and I will always respect the confidentiality of patient information.

Agreement: By submitting this application, I agree that I understand that volunteer applicants of Family Hospice must fulfill all Volunteer Services requirements, including completion of application, interview, tuberculosis test, proof of Covid-19 and flu vaccination, and proof of MMR if born in 1957 or later. I authorize Family Hospice to perform a criminal background check. If qualified for volunteer service, I agree to abide by the rules and regulations of Family Hospice, the policies and procedures of the volunteer program, and the role(s) to which I am assigned, and I will always respect the confidentiality of patient information. I also certify the application information is accurate and complete, and that Family Hospice may accept volunteers in its sole discretion and may release a volunteer at any time from serving the organization.