New User Details
Physical Therapy Volunteer Application
* Indicates Required Fields to Submit Application
Your Information
If less than five (5) years, please list your former state(s) of residence
Adult - 18+ year of age and completed highschool
Emergency Contact Information
Work Information
School Information
Community Involvement
Your Skills
Select any skills that apply to you from the listing below (select all that apply)
If you have ever been convicted of a felony, misdemeanor, or other criminal offenses and/or any arrests or pending criminal proceedings currently pending against you, please explain here:

Statement of Understanding And Agreement

Johns Hopkins All Children's Hospital is a drug free campus. I understand that by applying for a volunteer position, if accepted, I may be subject to a drug screening.

Johns Hopkins All Children's Hospital requires volunteers to commit to volunteering a minimum of a six month period (generally one day a week for two to four hours).  This requirement must be fulfilled in order to receive any correspondence (i.e. Hours, Letters of recommendation, etc...) from the Volunteer Resources Office.

I certify that the information given by me in this application is true in all respects and that I have not made any willful omissions. I agree to abide by all present and subsequent rules and regulations of Johns Hopkins All Children's Hospital and understand such rules and regulations may be modified at any time, such deemed necessary by Johns Hopkins All Children's Hospital.

I understand that if accepted into the volunteer program at Johns Hopkins All Children's Hospital that I am required to have immunity to Chickenpox, Measles, Mumps, and Rubella and to receive a flu shot annually. To verify immunity, I must provide the following information to All Children's Hospital Employee Health:
     Varivax (Chicken Pox)
           Written documentation with 2 doses of vaccine,
           Laboratory evidence of immunity,
           Diagnosis of history of varicella disease by a health-care provider, or diagnosis of history of herpes zoster by a health-care provider.

     MMR (Measles, Mumps, Rubella)
          Born in 1957 or later:
               Proof of immunity includes one of the following:
                    - Two vaccines after 12 months of age.
                    - Laboratory evidence of immunity for Measles (Rubeola), Mumps, and Rubella.

     Tetanus/Pertussis and Diptheria(Tdap)If you have never had a Tdap immunization you should receive a single dose of Tdap from your own doctor before you begin to volunteer.

     TuberculosisA TB screening will be provided by the hospital if your application is accepted.

Immunization/immunity records may be acquired from either your doctor, school, university, or the Public Health Department.

Furthermore, I understand that if selected to volunteer, disclosure of confidential information concerning the hopital or a patient may cause immediate dismissal. By submitting this application, I am agreeing to these requirements as set by the Johns Hopkins All Children's Hospital Volunteer Resources Office.