Name (required)

Mailing Address:

Your Email (required)

Main Phone #: (required)

Additional contact # (Cell/Work/Home)

In case of emergency, please notify:

Name:
Relationship:
Phone:

Employment

 Full Time Part Time

Educational background:

Would you be comfortable working with people who have very strong and very different religious and spiritual beliefs from your own?

Do you have any physical restrictions or pertinent health issues?

Please elaborate on any personal experiences with death:

Hospice volunteers can assist in various activities. Please check those that interest you:
 Patient care Fundraising or Public Events Administrative tasks Other
*Patient care: Sitting with patients to provide respite for family caregivers
*Fundraising or Public Education Events: Setting up and assisting with preparations for events
*Administrative tasks: Help with making phone calls or preparing large mailings
Other ideas on what else you would like to help us with:

Please tell us about your interest in volunteering for Hospice Maui:

Please tell us about your skills, education, life experiences that you would bring to your volunteering:

Are you available at least 2-4 hours a week?
 yes no

Languages Spoken:

Days and Hours per week that you would be available to volunteer:

Please check the areas that you would be willing to serve in:
 Kihei Lahaina Wailuku/Kahului Haiku, Makawao, Kula, Paia

*Please be aware that a background check will be made after successful completion of volunteer training.