Echelon username Last name First name Middle name Location Altamonte Apopka Celebration Children's Hospital Deland East Orlando Fish Heart of Florida Kissimmee Lake Mary Lake Wales Offsite Orlando Oviedo Waterman Winter Garden Winter Park Women's Hospital Type Adult Crafter Employee Student Employee Volunteer Pet Therapy Student - Intern Teen Clinical Preference clinical - Clinical no_preference - No Preference non_clinical - Non-Clinical Cell Phone Home Phone Email I am 16 or 17 years old Over 18 Parental Consent I, the undersigned, give my permission for my child, who is at least 16 years old, to participate as a teenage volunteer at AdventHealth Volunteer Services. I understand that my child is making a commitment to serve as a volunteer at AdventHealth Volunteer Services and I will support their participation, which includes reporting for duty as scheduled and calling their area of service when they are not able to attend. I understand that my child will be assigned to an available service suitable to their age and capabilities and if they are not able to perform their duties, may be reassigned to another area of service or terminated from the program. My child may refuse to do any task that may make them feel uncomfortable. I understand that while in a healthcare setting my child may interact with patients being cared for at AdventHealth Volunteer Services as well as those visiting AdventHealth Volunteer Services. I support my child's interest and participation in AdventHealth Volunteer Services's Volunteer Program and grant my consent. Last name First name Middle name Signature Emergency contacts Add This experience was at AdventHealth Volunteer Services Organization name Status Past Employee Current Employee Start date End date Department Prior work experience Add This experience was at AdventHealth Volunteer Services Organization name Type Volunteer Observation Intern Other Type other Start date End date Department Prior volunteer experience Add 08:00 - 12:00 12:00 - 16:00 16:00 - 20:00 Sunday Monday Tuesday Wednesday Thursday Friday Saturday Availabilities Add Address 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 Skip verification Applicant Signature I have reviewed the information above and confirm its accuracy
