Volunteer Application for Children's Village, North Star Lodge, Ohana, Snuggle Buddies and/or Hospital
Volunteer Services - 2811 Tieton Drive - Yakima, WA 98902 - 574-6729
Welcome to Memorial's Volunteer Program!
Thank you for your time and contribution!
As a volunteer in a health care setting, you must meet the same health requirements as employees. These requirements are for the safety of the patients we serve.
Health Requirements for Volunteers:
*Proof of vaccination or immunity by lab (titers) for: Measles, Mumps, Rubella
*Varicella (Chicken pox)
*Two Step Tuberculosis Skin Test
*Influenza Vaccine
All volunteers must be vaccinated annually in a timely manner and in accordance with the annual influenza policy. You may provide documentation if you receive your shot elsewhere. (Hint: To locate records check with: previous employers, parents/baby book, high school/college, physician, military, local/state health department. If you are unable to obtain these health records, Employee Health orders blood tests and provides vaccinations and/ or Tuberculosis testing, at no cost to you.)
NOTE: There is a Volunteer Orientation file you will be required to download at the bottom of the application. Please ensure that you either have the ability to download the files to your computer or onto a jump drive, so you are able to review the documents while you take our online quiz. Once your application has been submitted, you will be automatically redirected to our Orientation Quiz.
Emergency Contact Information
Disclosure Statement
Pursuant to the requirements of RCW 43.43.834, YVM must ask you to complete the following Applicant Disclosure Statement. This information will be kept confidential. Please answer fully and accurately.
1. Crimes Against Persons and Crimes Relating to Financial Exploitation:
Have you ever been convicted of any of the crimes listed below?
If Yes, check all that apply and describe at number 4 below.
2. Drug-Related Crimes
Have you ever been convicted of a crime related to the manufacture of, delivery of, or possession with intent to manufacture or deliver a controlled substance?
3. Have you ever been found by any agency, court or disciplinary board final decision to have committed any of the following acts against a child, a vulnerable adult or developmentally disabled person:
Domestic Violence?
Sexually assault or abuse?
4. For all items where you have answered yes in 1-3 above, specify the conviction, finding or action date(s), specify the sentence(s) or penalty(ies) imposed, prison release date(s) and current standing (e.g., parole, work release). For all Items with an asterisk (*) above, provide a description of the victim including the victim's age. Please use text box, if needed.
5. Have you ever been convicted of any other crime? If yes please identify the offense(s), provide the date(s) of the conviction(s), the name of the court, (e.g., Yakima county Superior Court) and the sentence imposed.
Memorial is responsible for securing its computer systems, associated data, and communications network. In addition,YVM and affiliated agency employees are responsible for preventing the occurrence of inappropriate, unethical, or unlawful use of such systems and data.
