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Adult Volunteer Application

* Required Info
 

Areas of Interest: Please check all that apply:








 

 
 

Have you ever been convicted of a crime, other than minor traffic violations?

 
Note: Answering "yes" does not necessarily disqualify you from volunteering
 
 
What is your availability?
 
 
 
 

List the names and numbers of two personal references that are not kin:

I authorize Baptist Health Deaconess Madisonville to request information concerning my character and reliability from the above named references.
 
 
 
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