I understand and agree that at no time will any information regarding patients of Ballad Health be revealed to anyone other than those authorized to receive it. I understand that the giving of the information concerning a patient to those not authorized to receive such information is unlawful and shall be sufficient cause for my immediate dismissal.
I agree to any necessary health screening required by the hospital and understand my volunteer assignment is contingent upon successful completion of this screening. I UNDERSTAND I MUST HAVE a Two-Step TB SKIN TEST (and Flu Vaccine during flu season) BEFORE I CAN BEGIN VOLUNTEERING. The hospital will perform the TB skin tests and flu vaccine at no charge to the volunteer.
I understand that false statements made as a part of this enrollment may be considered sufficient cause for dismissal.
I authorize and consent for all named references and educational institutions or previous places of employment to release any personal and/or professional information about me to the Ballad Health Volunteer Office. I also consent to a law enforcement record search and/or any other background investigation of me if chosen by the Volunteer Office. I understand I have consented to these things as described herein, and in doing so, I further release, hold harmless, and indemnify Ballad Health, the Volunteer Office, and any and all Ballad Health employees, officers, directors, and/or authorized agents, as well as those individuals or entities supplying such information about me, and/or conducting such search and/or investigation, from any liability, claims and/or causes of action as a result of any such inquiry, search and/or investigation. I understand and agree that submitting this form does not automatically register me as a BalladHealth volunteer and that there may be certain qualifications I must meet, including the acceptance of established volunteer policies and procedures before I may begin volunteering.
I UNDERSTAND THAT IF I AM ACCEPTED AS A VOLUNTEER:
- I will abide by Ballad Health general policy concerning patient
- My assignment is on a probationary basis for a period of 60
- I voluntarily offer my services with a clear understanding that there is no monetary compensation due to me as a result of my services, and Ballad Health is not legally liable for any worker’s compensation coverage or other similar benefits as a result of my services
- Photos taken while participating as a Ballad Health volunteer or at special functions may be used for promotional purposes.
- I will observe all hospital regulations.
All fields marked with asterisk (*) are required.