Apply to become a volunteer

First Name:

Last Name:

Email Address:

Home Address

Phone Number:

Emergency Contact Name:

Emergency Contact Number:

Days you are available: Monday

Monday 9am - 12pm

Monday 12pm - 3pm

Monday 3pm - 6pm

Monday 6pm - 9pm

Tuesday

Tuesday 9am - 12pm

Tuesday 12pm - 3pm

Tuesday 3pm - 6pm

Tuesday 6pm - 9pm

Wednesday

Wednesday 9am - 12pm

Wednesday 12pm - 3pm

Wednesday 3pm - 6pm

Wednesday 6pm - 9pm

Thursday

Thursday 9am - 12pm

Thursday 12pm - 3pm

Thursday 3pm - 6pm

Thursday 6pm - 9pm

Friday

Friday 9am - 12pm

Friday 12pm - 3pm

Friday 3pm - 6pm

Friday 6pm - 9pm

Saturday

Saturday 9am - 12pm

Saturday 12pm - 3pm

Saturday 3pm - 6pm

Saturday 6pm - 9pm

Sunday

Sunday 9am - 12pm

Sunday 12pm - 3pm

Sunday 3pm - 6pm

Sunday 6pm - 9pm

Which Hospital:

Wellington

Kenepuru

Why are you interested in becoming a volunteer in the Hospital? Where did you learn of our service?

Special Interests, hobbies and memberships

Other volunteer experience

Are there any health problems / physical limitations which might limit your ability to work as a volunteer

Do you have any recent or current experience either personally or in your family of hospitalisation or serious illness?

We are committed to the protection and privacy of our patients. Their interests and welfare are paramount. Please give us the names of two people we may contact who have known you for more than one year. Do we have permission to contact your referees?

Referee One Name:

Referee One Address:

Referee One Phone (business):

Referee One Phone (after hours):

Capacity in which you know referee One

Referee Two Name:

Referee Two Address:

Referee Two Phone (business):

Referee Two Phone (after hours):

Capacity in which you know referee Two

Apply to become a volunteer

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