Concord Medical Center High School Volunteer Application form

Your account password must contain at least one capital letter, one lower case letter, one number and be at least 8 characters long.

Do not submit your application here if you are a legacy student* or attend one of the following high schools: Acalanes, Athenian School, Berean Christian, California, Campolinda, Carondelet, De La Salle, Dougherty Valley, Las Lomas, Miramonte, Monte Vista, Northgate, San Ramon Valley, Ygnacio Valley

*A legacy student is the child of JMH staff or volunteers, or the sibling of a child who has gone through the Walnut Creek H.S. program previously.

Please contact the College/Career Counselor at your school to get an application for our Walnut Creek High School Volunteer program or for Legacy applications, contact Stacy Appel at stacy.appel@johnmuirhealth.com.

New User Details

User ID

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Password

Password (verify)

Concord Medical Center High School Volunteer Application Form

Please enter your name as you want to be known, and how it should appear on your ID Badge.

* First name

* Last Name

Phone (Home)

* Phone (Mobile)

* E-mail

* Street Address

Apt. number

* City

* State

* Zip/postal

* DOB

* Name of High School

Graduation year

* Parent #1/Guardian's Name

* E-mail

Home Phone

* Cell Phone

Business Phone

Parent #2/Guardian's Name

E-mail

Home phone

Cell phone

Business phone

In an Emergency, we should contact

* Emergency Contact Name

* Phone (Home)

* Your relationship to this person?

* Primary Language Spoken for Emergency Contact

If you have ever been a volunteer in another organization, please list them:

Hobbies/Special Interests:

Skills/Talents:

Organizations (Religious/School/Community/Other):

In addition to English, do you speak any languages fluently?

If parent/guardian is an employee/volunteer of John Muir Health, which department do they work in?

Ethnicity

Opportunities for volunteers are provided without regard to religion, creed, national origin, age, gender or sexual orientation.

* Please write a short essay about your reasons for volunteering

Signature
Please click and hold your mouse to write your signature in the box below.

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Signature

Your signature above, confirms that the above information is accurate and correct to the best of your knowledge.