If you would prefer to submit this form via mail, please print the application and mail to:

Volunteer Services Department
18101 Prince Philip Dr.
Olney MD 20832

You will be contacted if an opportunity becomes available that fits your interests.All applicants must be age 16 or older.

For questions regarding the volunteer application please call 301-774-8629 or email [email protected].

This form is secure, and the information that you provide is confidential.

* required information

Contact and Basic Information
Prefix
First Name*
Last Name*
Date of Birth*
Address*
City*
State*
Zip*
Telephone Number*
Cell Phone Number*
Email Address*
Have you ever been employed or assigned to work at MedStar Montgomery Medical Center or any other MedStar Health facility?
Do you have any relatives employed or volunteering at MedStar Montgomery Medical Center?
Present Occupation/School
If retired, what was your occupation prior to retiring?
Skills
Please select all skills that apply* Computer
Marketing
Physical Therapy
Public Speaking
Microsoft Word
Microsoft Excel
Filing
PowerPoint
Accounting/Math
Writing & Composition
Other
Availabilty
Monday* 8 a.m. to noon
4 to 8 p.m.
Noon to 4 p.m.
I am not available
Tuesday* 8 a.m. to noon
4 to 8 p.m.
Noon to 4 p.m.
I am not available
Wednesday* 8 a.m. to noon
4 to 8 p.m.
Noon to 4 p.m.
I am not available
Thursday* 8 a.m. to noon
4 to 8 p.m.
Noon to 4 p.m.
I am not available
Friday* 8 a.m. to noon
4 to 8 p.m.
Noon to 4 p.m.
I am not available
Saturday* 8 a.m. to noon
4 to 8 p.m.
Noon to 4 p.m.
I am not available
Sunday* 8 a.m. to noon
4 to 8 p.m.
Noon to 4 p.m.
I am not available
Accommodations
Are there any limitations on your activities?
Volunteer Preference Area
Please select the area in which you would like to volunteer.* Main Information Desk
Emergency Dept. Greeting Desk
Surgery Waiting Area Desk
Nursing
Admissions
Reference Contact Information (cannot be a relative)
Reference Name*
Reference Address*
Why do you want to be a hospital volunteer?*
Emergency Contact Information
Emergency Contact*
Emergency Contact Relationship*
Emergency Home Phone
Emergency Cell Phone*
*I understand that, if accepted to participate in the Volunteer Services Department at MedStar Montgomery Medical Center, a minimum commitment of 100 volunteer hours will be honored on my part.

I understand that I may occasionally be exposed to information of a confidential nature pertaining to patients in the course of my volunteer work. I further understand that this information is to be kept confidential, and I will not disclose such information or discuss it with anyone. I also understand that the casual sharing of patient information in public places or settings is inappropriate. The only exception may be taking telephone messages from patients or family members, or about patients/families, and passing such messages along to the appropriate staff member. All offers are made conditional on the satisfaction of completion of a new volunteer health screening, drug clearance, background check, and references.

Signature*
Date*