Personal Information
Employment Information
Are you currently employed? yes no
Student Information
Are you currently a student? yes no
Reference #1
Reference #2
Emergency Information
Volunteer Experience
Experience #1
Experience #2
Volunteer Information
I-shine Operates Monday & Wednesday 3:45-6:30PM

Please select the days you are available to volunteer
Monday Wednesday Both Monday & Wednesday
Agreement Information
Have you ever been convicted of any crime, including sex-related or child abuse related offenses in any state or country?
yes no
I have truthfully completed this application. I will honor the time commitment required for my volunteer assignment and will adhere to all policies and procedures outlined in any materials provided by Chai Lifeline.

Agreement of Confidentiality
As an i-Shine volunteer, I understand that in the course of my work with this program, I might learn privileged and confidential information about the children and their families, including, but not limited to medical conditions and treatment, finances, living arrangements, employment, and/or relationships among family members. I understand that all such information must be treated as confidential. I agree to disclose any information learned about patients and their family members only to one of the adult coordinators of the program. I understand unauthorized disclosures are considered grounds for immediate termination of volunteer status.
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