Ongoing Volunteer

Due to extenuating circumstances of COVID-19, Connecticut Children's is suspending all volunteer programming until further notice.
Our 2020 Summer Program has been cancelled.

New User Details

User ID

User ID (verify)

Password

Password (verify)

*Highlighted fields are required

* First Name

Middle Initial

* Last Name

* Date of Birth (mm/dd/yyyy)

Address Information

* Home Address

Apt.#/Suite

* City

* State

* Zip

Phone (Home)

Phone (Mobile)

E-mail
This e-mail address will be used for all ongoing correspondence.

Connecticut Children's Employee Referral Information

Do you have relatives employed at Connecticut Children's?
If YES, please complete name, relationship, and department information below.

Referred by:
Name

Relationship

Department

Comments

Prior Service History

Have you or any family member ever received services
at Connecticut Children's or any of their satellite locations?

If YES, date of most recent visit

Employment Information

Are you presently employed?

If yes, what kind of work do you do?

Listed below are our current placement opportunities.

Placement in the Volunteer Program is based on current
needs, your availability, and department-specific
requirements.

Because our needs are constantly changing,
please check back if you don't see
something that fits your present availability.

(Choose all that apply)

Child Life
Minimum Age - 18

Clerical
Minimum Age - 15

Current Openings

Emergency Dept
Minimum Age - 16

Gift Shop
Minimum Age - 16

NICU - Farmington
Minimum Age - 21

NICU - Hartford
Minimum age - 21

Surgical Lounge Liaison
Minimum Age - 21

Tell Us About You

* Why do you want to volunteer at Connecticut Children's?

What qualities, skills and knowledge do you have
that would make you a great volunteer?

Describe what you hope to gain through your volunteer
experience at Connecticut Children's.

* What is your experience with working with a variety of people?

* What are your hobbies and interests?

Other organizations to which you have provided
volunteer services:

Please provide the name and e-mail address of
two people who know you well and whom we may
contact for references. They should not be
family members.

Name

Relationship

E-Mail

Name

Relationship

E-Mail

Immunization Requirements

An Immunization Documentation Form

Link Here
signed by your healthcare provider must be
included with your application submission.

If accepted into the program, you will have a
maximum of two weeks to provide documentation
of either a 2-Step PPD OR negative QuantiFERON test.

* Immunizations

* MMR#1

* MMR#2

* TDAP

PPD#1

PPD#2

Titers

Titer Documentation

QuantiFERON

QuantiFERON Documentation

I understand that any volunteer joining Connecticut Children's
during flu season will be required to show documentation
of a current influenza vaccination, and an annual vaccination
is mandatory for continued participation in the program.

Additional Information

The documentation listed as required must be submitted
in order for your application to be considered complete.

If accepted into the program, would you be willing
to submit to a criminal background check?

Current Photo

Volunteer Agreement

Confidentiality

Parental Consent

Consent for Treatment

By submitting my application,I understand that Connecticut Childrens
will consider me for a volunteer position on the basis of the
information I have furnished on this application form, and that
any false, misleading or incomplete statements made by me,
or any omission of material fact shall prevent my volunteering or
shall be cause for immediate dismissal from my volunteer assignment.

I understand that the staff of the Volunteer Services Department
will be calling the references I have listed on this application,
and conducting a background check on me prior to being placed.
As part of the volunteer application process, and at any time
during my volunteer placement, I authorize Connecticut Childrens
or any of its affiliates to obtain the record of any conviction for
commission of a felony.