Volunteer Form

If you are interested in becoming a Coastal Hospice volunteer, please fill out the form below. If you have any questions, please contact volservices@coastalhospice.org or call  410-543-2590.

Volunteer Form

Volunteer Form

I am Interested in the Following:

Select Your Interest(s)

Personal Information

Address
Address
City
State/Province
Zip/Postal
Are You A Veteran?
Preferred Method of Contact
Send Newsletter
Do you have General Maintenance and Repair Skills
Ability to stand for six hours
Ability to lift, move, and carry up to 25 pounds without assistance (80% of the shift)

Other Work Experience

Education

Special Skills

Availability

  • Sunday
  • Monday
  • Tuesday
  • Wednesday
  • Thursday
  • Friday
  • Saturday
MorningAfternoonEvening
Preferences

References

Coastal Hospice underwriters require confirmation of your personal automobile insurance. Please attach a copy of your driver’s license and declarations page from your automobile insurance policy, which states the limitations of coverage. Note that you must have received the COVID-19 vaccine and be able to show proof of the immunizations to become a Coastal Hospice Volunteer.

Notify in case of emergency

Possess a License/Certificate/Registration

If you possess a license, certificate or registration as a result of specialized education or training, please complete the following:
Do you Possess a License
Do you carry professional liability insurance?

Signature

Coastal Hospice underwriters require confirmation of your personal automobile insurance. Please attach a copy of your driver’s license and declarations page from your automobile insurance policy, which states the limitations of coverage. Note that you must have received the COVID-19 vaccine and be able to show proof of the immunizations to become a Coastal Hospice Volunteer
I confirm that I am fully vaccinated for COVID-19

By submitting this form, I hereby authorize Coastal Hospice, Inc., to ascertain any and all information which may be pertinent to my volunteer duties. I release any individual from all liability for damages that may result to me on attempts of compliance or any attempts to comply with this authorization.

Coastal Hospice underwriters require confirmation of your personal automobile insurance. Please attach a copy of your driver’s license and declarations page from your automobile insurance policy, which states the limitations of coverage.

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About Us

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