Connecticut Childrens Large

Note: COVID-19 Vaccines, Boosters and Flu shots (during flu season) are mandatory for participation in our volunteer program


New User Details
*Highlighted fields are required

Address Information

Emergency Contact


Placement Information

Immunization Information

Before completing this form, please download a copy of the Immunization Documentation Form to assist you in completing the information below. You will also be required to upload a completed signed version of this document before clicking submit.

By submitting my application, I understand that Connecticut Children's
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 Children's
or any of its affiliates to obtain the record of any conviction for
commission of a felony.