TestPage - Lifesong Hospice

First Name*

Middle Name

Last Name*

Contact Phone Number*

Date available to begin:

Volunteer Activity Interest (Check all that apply)
Partnering with a patient/resident (sending cards, making telephone calls)Planning special events (birthday celebrations, etc.)Making bereavement callsBaking bereavement breadsCreating legacy projectsPlanning veteran’s pinning ceremoniesMaking lap robes, walker bags, and/or fidget apronsAssisting in the Lifesong Office (administrative tasks, copying, filing, etc.Other unique opportunities

List any skills or training that may be helping when volunteering with Lifesong

Are you fluent in a language other than English?

How did you learn about Lifesong?

Why do you want to be a volunteer?

Have you had a significant loss in your personal life in the past six months?

Are you a veteran of the U.S. Armed Forces?

Have you ever been or plead guilty to a felony, misdemeanor, or other crime?

(this does not include minor traffic violations)

I certify that all information in this volunteer application and other documents accompanying it are accurate. I understand that misrepresentatvion or material omission of information is grounds for removal forconsideration or dismissal from a volunteer position. I authorize Lifesong to verify or otherwise investigate, without liability all statements contained in this application. I understand this appilication is not, nor is intended to be a contract of employment. *
Please check to confirm the above statement.
Your privacy is important to us. If you have any questions on how we use the information provided in these forms, please see our Privacy Policy .

Address

Lifesong Hospice & Palliative Care
3880 TecPort Drive
Suite 2
Harrisburg, PA 17111
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Say Hello

Local: 717-585-6687
Toll Free: 855-411-7722

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