St. Mary's Hospital - Decatur Volunteer Volunteer Form Volunteer Form To become a hospital volunteer, please fill out the form below or print out the printer-friendly form and deliver to the information desk at the hospital. Print out the form to sign up or fill out below Calendar: CalendarToday First Name: Middle Initial: Last Name: Date of Birth: CalendarToday Email: Primary Phone Number: ( ) - Second three digits Last four digits Secondary Phone Number: ( ) - Second three digits Last four digits Last 4 digits of SSN#: Required for computer accessAddress: City: State: ZIP Code: Education or Special Training: Volunteer Experience: Have you ever been convicted of, or plead guilty to a crime which includes a felony or misdemeanor after you turned 16 years of age?: YesNo If yes, please describe in detail: Emergency Contact Name: Relationship: Phone Number: ( ) - Second three digits Last four digits Address: City: State: ZIP Code: Personal Reference Name: Address: City: State: ZIP Code: Areas of service preferred: Preferred Days - First Choice: SundayMondayTuesdayWednesdayThursdayFridaySaturday Preferred Days - Second Choice: SundayMondayTuesdayWednesdayThursdayFridaySaturday Preferred Hours: MorningAfternoonEvening Are you available on weekends?: YesNo Can you be called to substitute?: YesNo Comments: