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Hospice Savannah
People with a gift for helping. ™
912.355.2289
Contact Us
1352 Eisenhower Drive Savannah, GA 31406
1352 Eisenhower Drive
Savannah, GA 31406
I’m Living With an Illness
Hospice Care
Where We Help
The Butterfly Program & Pediatric Hospice Care
Cardiopulmonary Program
Your Team of Helpers
Help in Your Home
Help in Your Nursing Home or Assisted Living
Help in our Hospice Inpatient Unit
Music, Massage, Story Keeping
Helping Pets
Helping Veterans
Frequently Asked Questions
Helpful Links
Helpful Videos
Watch as Caregivers Talk About Our Care
Advance Directives
Nondiscrimination and Accessibility
Palliative Care
The Steward Center
Help When You Are Not Ready for Hospice
Helpful Videos
Advance Directives
I’m Caring for Someone
Caregiver Support
The Edel Caregiver Institute
Caregiver Classes and Support Group
Caregiver Support Calendar
Helpful Links for Caregivers
Advance Directives
I’m Grieving a Loss
How We Can Help
Camp Aloha: Helping Children
Grief Support Schedule
Voices That Heal
Suggested Reading List
Helpful Videos
I Want to
Donate
How You Can Help
Make a Donation Now
Golf Tournament
Thrift Shoppe
Tree of Light: Remember your loved one
We Remember Mama
Summer Night Parties
Hospice Savannah Art Gallery
Volunteer
Grateful Family Program
Who We Are
COVID-19 Precautions & Vaccinations
Patient & Family Guide
Blog
Our History and Mission
Our Leadership and Physicians
Our Boards
Quality Measures
Careers
Our Affiliations
Annual Report
Privacy Policy and Terms of Use
E-Newsletter Archive & News Coverage
Clinical Education
Community Seminars
Search:
I’m Living With an Illness
Hospice Care
Where We Help
The Butterfly Program & Pediatric Hospice Care
Cardiopulmonary Program
Your Team of Helpers
Help in Your Home
Help in Your Nursing Home or Assisted Living
Help in our Hospice Inpatient Unit
Music, Massage, Story Keeping
Helping Pets
Helping Veterans
Frequently Asked Questions
Helpful Links
Helpful Videos
Watch as Caregivers Talk About Our Care
Advance Directives
Nondiscrimination and Accessibility
Palliative Care
The Steward Center
Help When You Are Not Ready for Hospice
Helpful Videos
Advanced Directives
I’m Caring for Someone
The Edel Caregiver Institute
Caregiver Classes and Support Group
Caregiver Support Calendar
Helpful Links for Caregivers
Advance Directives
I’m Grieving a Loss
How We Can Help
Camp Aloha: Helping Children
Grief Support Schedule
Suggested Reading List
Helpful Videos
I Want to Donate
How You Can Help
Make a Donation Now
Golf Tournaments
Thrift Shoppe
Tree of Light: Remember your loved one
We Remember Mama
Summer Nights Parties
Hospice Savannah Art Gallery
Volunteer
Grateful Family Program
Who We Are
COVID-19 Precautions & Vaccinations
Blog
Our History and Mission
Our Leadership and Physicians
Our Boards
Quality Measures
Careers
Our Affiliations
Annual Report
Privacy Policy and Terms of Use
E-Newsletter Archive & News Coverage
Clinical Education
Community Seminars
Careers
Camp Aloha Volunteer Application
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Camp Aloha Volunteer Application
VOLUNTEER GENERAL INFORMATION
Name
*
First
Last
Address
Street Address
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Home Phone
Work Phone
Email
*
Date of Birth
MM
DD
YYYY
Occupation
Employer
Employer Address
EDUCATION HISTORY (HIGHEST DEGREE EARNED)
Name of School
Degree/Date
MM
DD
YYYY
Course of Study
PROFESSIONAL LICENSE AND/OR CERTIFICATIONS
Type
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Date
MM
DD
YYYY
Number
Expiration Date
MM
DD
YYYY
Type
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Date
MM
DD
YYYY
Number
Expiration Date
MM
DD
YYYY
What eperience have you had working with children?
*
What are your areas of interest for volunteering? (check your top 3)
*
Assisting with camp registration (Friday Only)
Cabin Counselor
Camp Nurse
Camp Preparation
Group Helper
Group Leader
Lifeguard (Saturday Only)
Photographer
In what camping/outdoor experience have you participated?
*
With what age group do you prefer to work (first choice)
*
6-7
8-9
10-12
13-18
What age group would be your second choice?
*
6-7
8-9
10-12
13-18
PERSONAL REFERENCE
Name
*
Relationship
*
Address
*
Phone
*
PROFESSIONAL REFERENCE
Name
*
Relationship
*
Address
*
Phone
*
EMERGENCY AND MEDICAL INFORMATION
In case of emergency please notify:
Relationship
Address
Day Phone
Work Phone
Please list any medical issues we need to be aware of, including serious allergies:
Please list any medications you are currently taking:
Do you have health insurance?
*
Yes
No
If yes, give name of company
Policy Number
Policyholder's Name
Doctor's Name and Phone Number
I know of no health reason(s) other than the information indicated on this form that would prevent my participation in any of the Camp Aloha activities.
I fully agree with this statement.
I do not agree with this statement.
By typing name and date in this box, I attest that all answers are true and valid.
I authorize Hospice Savannah, Inc., or local media and other professionals assisting Hospice Savannah, to record images of me and conduct interviews with me that may be seen and heard by the general public or used for performance improvement or education purposes. I understand these images may be used for educating the public about Hospice Savannah care or promoting programs and services offered by Hospice Savannah and that I have the right to rescind this consent prior to the use of the recording or film.
*
I fully agree with this statement.
I do not agree with this statement.
I understand that information regarding Camp Aloha campers, their families, staff and any persons receiving support or services in any capacity is privileged information for use by authorized person(s) only. I will disclose such information only to person(s) authorized to receive such information through the signed consent of patient, family member of affected party. I will not disclose any information to anyone unauthorized to receive this information. I will handle any and all paperwork and forms with proper procedure of control so that no information is accidentally observed or released to any unauthorized person(s). I understand that the casual sharing of camper/camper families/staff information in public places or settings is inappropriate including social media postings (i.e. Facebook, Twitter, etc.).
*
I agree to abide by this statement of confidentiality.
I do not agree to abide by this statement.
I understand that Camp Volunteer Orientation is required of all first-time volunteers and encouraged for returning volunteers.
*
Yes
No
I understand that a criminal background check is required of all camp volunteers unless currently employed by Hospice Savannah and authorize Hospice Savannah to conduct this check upon my completion of the proper authorization form.
*
I agree with this statement.
I do not agree with this statement.
Camp Volunteer T-Shirt Size
*
S
M
L
XL
2XL
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