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Life Care Home Health, Inc. provides home health, hospice, and private duty services in nine states, turning homes into healing environments.

Volunteer Registration

Please fill out the form below to register with our volunteer program.

Contact Details

Name: *		Your name is required.
Email:
Church:
Address:
City:
		State: Zip:
Phone: *		Your phone # is required.
Other Phone:

Information

Education and work experience summary:

Present Occupation:

Place of Employment:

Please indicate any special interests or hobbies that you have.

Indicate the services you are NOT interested in providing at Affinity-Hospice of Life:

Direct Work with Patients/Families	Clerical Office Help
Public Relations	Bereavement Follow-Up
Special Events
Days/Times Availability
Preferred number of hours per week
How long do you feel that you will be an active hospice volunteer?
Do you have a preference?
Non-smoking	Smoking environment okay
No dogs	Dogs okay
No cats	Cats okay
May we assign you to work with both male and female patients? Yes No
If no, please indicate preferred patient gender? Male Female

Why do you want to become involved with the Hospice volunteer program?

* Indicates a required field