Welcome to an overview of the Lakeland Regional Medical Center Teen Volunteer Program form—a comprehensive entry to what could be a transformative experience for high school students looking to explore the world of healthcare. With a deep commitment to personal growth, responsibility, and professional development, the program presents an invaluable opportunity for teens at least 15 years of age to serve in a capacity that familiarizes them with patient care services. From the outset, interested students are greeted with warmth, encouraged to engage in this rewarding journey, and reminded of the pivotal role they play within the hospital environment. The form itself is a gateway, detailing a step-by-step process including the submission of a notarized parental consent form, proof of vaccinations, and a letter of recommendation, among other requirements. A highlight of the program is the emphasis on professionalism and ethics, mirroring the expectations placed on hospital employees. Volunteers are expected to exhibit dependability, responsibility, and a willingness to learn and adapt—qualities that are nurtured throughout their tenure. Additionally, the program outlines specific commitments related to conduct, appearance, and confidentiality, ensuring volunteers uphold the standards of the hospital while providing service. Detailed within the form are logistical aspects such as uniform guidelines, meal arrangements, and procedures for reporting volunteer hours, all designed to integrate volunteers seamlessly into the hospital setting. The form also lays out the pathway for volunteers who wish to continue their service beyond the summer, including necessary medical screenings and the process for rejoining the program in subsequent years. This introductory snapshot offers a glimpse into a program poised to shape the next generation of healthcare professionals by fostering a spirit of volunteerism and a dedication to compassionate patient care.
| Question | Answer |
|---|---|
| Form Name | Lakeland Regional Medical Center Teen Volunteer Program Form |
| Form Length | 8 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 2 min |
| Other names | MMR, 1st, 30th, childs |
Thank you for your interest in the Lakeland Regional Medical Center Teen Volunteer Program. Attached are several documents that must be completed and returned to the Volunteer Services office no later than:
Friday, March 30th 2012.
For many students, this may be the first exposure to the field of patient care services. It is our
desire to keep everyone well informed, enthusiastic, and interested in his or her volunteer experience. We’re proud that many of our volunteers continue to participate throughout their
high school years and pursue medical careers upon graduation.
The following are requirements everyone must meet to be accepted into the Teen Volunteer Program:
1.You must be a high school student at least 15 years of age.
2.Complete and notarize the parental consent form and return it with the application form
3.Furnish proof of 2 Measles/Mumps/Rubella (MMR) Vaccinations (available from your Pediatrician or the Health Department).
4.Students it is your responsibility to call and schedule an interview AFTER receiving notification. Interviews will be held in April and you will be notified of the interview dates.
5.Submit a letter of recommendation from a school Guidance Counselor, Teacher and or Administrator. Please use the form attached. It must be in a sealed envelope.
6.Keep the top 4 sheets for your reference and mail the completed application to: Lakeland Regional Medical Center, 1324 Lakeland Hills Blvd, Lakeland, FL 33805
Attention: Volunteer Services
If we may assist you in any way, please feel free to call the Volunteer Services office at
Sincerely,
LRMC Volunteer Services Staff
Welcome to the Lakeland Regional Medical Center
Teen Volunteer Program
As a member of our Teen Volunteer Program, you will find a personal satisfaction in serving the hospital and our patients as you offer your time and talents. You will have the opportunity to acquaint yourself with a variety of health careers. You will learn new skills and enjoy this adventure into the adult world.
Remember, as a Teen Volunteer you agree to the following commitment.
I Will Be:
DEPENDABLE:
I will be on time for duty. If I am unable to report for duty, I will notify the supervisor that I have been assigned to. I will notify my supervisor or the Volunteer Coordinator in advance of vacation or other scheduled absences.
COOPERATIVE:
I will only work the service I am assigned. If I would like to change services, I will discuss this with the Director of Volunteer Services or the Volunteer Coordinator.
RESPONSIBLE:
I will wear my name badge at all times. I will not bring valuables with me.
I will report any accidents or incidents while on duty to my supervisor, the Director of Volunteer Services or the Volunteer Coordinator.
I will only go into parts of the hospital that are assigned to me.
QUIET:
I will walk and talk quietly in the hallways and rooms.
PLEASANT AND COURTEOUS:
I will remember that I am part of the patient care team and thus contribute to the impression others have of LAKELAND REGIONAL MEDICAL CENTER.
WILLING:
I will be a willing Volunteer, remaining flexible to serve where needed.
REMEMBERING:
I will remember that I am a teenager working in the adult world of medical science. As a Teen Volunteer in the hospital, I must observe the same professional ethics as the employees. To the public I appear as a professional. I must act in a professional manner
I WILL NOT:
Sit on a patient’s bed.
Make personal telephone calls or text while on duty. Cell phones will remain off for the duration of your shifts unless on break.
Visit with friends while on duty. Bring guests to work with me.
Use perfume, highly scented powder, cologne or after shave lotion.
Wear conspicuous
Chew gum, carry snacks with me, or smoke while on duty.
Sit in or ride in wheelchairs.
Play on the elevators.
Accept tips
Be sure to review additional requirements and rules in the Volunteer Handbook you receive during orientation.
MEALS:
You will be given a meal card for your use when on duty. Volunteers are responsible for charges above $6.00.
Do not take your lunch or dinner break during your
Arrange to take your meal break during a convenient time frame for the service area.
UNIFORM:
Teen Volunteers are required to wear the red uniform shirt and khaki pants when on duty. Predominantly white tennis shoes should be worn. You may not wear shorts, skorts, any pants made of denim fabric. Capri pants will be allowed as long as they are no more than 4 inches above the ankle.
If you report for duty out of uniform, you will be sent home. If you report for duty out of uniform a second time, you will be released from service.
SERVICE HOUR REPORTS:
You will receive a service report and certificate in September with a complete record of your volunteer hours. These reports are based on the information on the
The Volunteer Coordinator or the Director of Volunteer Services can sign Community Service forms.
DISMISSAL FROM PROGRAM:
At LRMC, our first concern is for our patients. Volunteers who show disregard for Hospital Policies will result in dismissal from service.
PATIENT CONFIDENTIALITY:
Hospital policy and Federal regulations require all patient information to be kept confidential. Volunteers who breach patient confidentiality will be terminated immediately.
VOLUNTEER WORK DURING THE SCHOOL YEAR
Once you have successfully completed a summer in our Teen Volunteer program, you may return on holidays, hurricane assistance or for other special events during the school year to earn additional service hours. You must call the Volunteer Services office or your volunteer supervisor first to see what needs we have for additional volunteers.
You may also return during subsequent summers if you receive a positive evaluation. Please call the Volunteer Services office by April 1st each year to advise us that you will be returning.
State law requires that all health care workers (paid and
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NAME _______________________________________________________________________________________
ADDRESS_____________________________________________________________________________________
CITY___________________________________________________ |
ST___________ ZIP __________________ |
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TELEPHONE – Home ___________________________ |
Cell: _______________________________________ |
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SCHOOL_________________________________________________ |
CURRENT GRADE __________________ |
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YEAR EXPECTED TO GRADUATE _____________ |
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SOCIAL SECURITY __________________________________ |
BIRTH DATE _____________________________ |
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PARENT/LEGAL GUARDIAN ______________________________________________________________________
DAYTIME PH#___________________ CELL _________________________ PGR: _______________________
WHY DO YOU WANT TO PARTICIPATE IN OUR TEEN VOLUNTEER SUMMER PROGRAM? (this must be completed)
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IN CASE OF AN EMERGENCY INVOLVING THIS TEENAGER WHILE ON DUTY YOU MAY CONTACT THE
FOLLOWING INDIVIDUALS IF PARENT/GUARDIAN IS NOT AVAILABLE
NAME__________________________________________________ PHONE ______________________________
NAME__________________________________________________ PHONE ______________________________
I hereby state that my son/daughter is in grade 8 or higher. I give my consent for him/her to serve as a volunteer in the Teen Volunteer program at LRMC. I have also read the list of rules and regulations concerning the program, and have discussed them with my son/daughter. He/she understands that breach of patient confidentiality will be cause for immediate termination from the program.
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PARENT’S SIGNATURE
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APPLICANT’S SIGNATURE
App. Received __________ Interview date __________ Medical Release Received __________
Recommendation Form Rcvd __________ Immunization Records Received: __________ PPD Completed __________
For Office use only
Lakeland Regional Medical Center
Parental Consent
I understand that my child, ___________________________________ (print name of child) who is
under eighteen (18) years of age and unmarried, has applied for membership as a Teen Volunteer at Lakeland Regional Medical Center (LRMC). I am aware that before serving as a Teen Volunteer, the
following documentation or certified proof of laboratory test results must be obtained from the public health department or my child’s physician and provided to the Volunteer Office:
1.Documentation of receipt of two (2) doses of MMR vaccine on or after twelve (12) months of age or laboratory evidence of Rubella (German Measles) and Rubella (Measles) immunity.
2.Documentation of negative Tuberculosis (TB) skin test within the past six (6) months or if TB skin test is positive, documentation of negative chest
In the event the results of the TB skin test are unavailable, I hereby authorize the administration of a
TB skin test to my child by personnel from LRMC’s Employee Health Services. If the results of said test are positive, I further consent to having a chest
In the event my child is injured or becomes ill while at LRMC, I hereby authorize LRMC and its personnel to provide appropriate medical care or treatment to my child, as they deem necessary or advisable.
I acknowledge that I have read this consent form in its entirety and understand fully its contents and voluntarily execute it realizing what I am doing by signing it. I further acknowledge that all my questions have been answered to my satisfaction and that I have proper legal custody of my child named above.
(This consent form must be signed in the presence of two (2) Employee Health witnesses or a notary public.)
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Date |
Parent or Legal Guardian’s |
______________________________ |
_______________________________________________________________ |
Witness |
Parent or Legal Guardian’s |
______________________________ |
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Witness |
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State of Florida
County of _____________
The foregoing Teen Volunteer Parental Consent form was acknowledged before me this _____ day of _______ in the year
_____________ ,by (name of parent or guardian) who is known to me or who has produced
(type of identification) and who did not take and oath.
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Name of Person Taking Acknowledgement
________________________________________________________________________
Signature of Person Taking Acknowledgement
________________________________________________________________________
Title or Rank
Lakeland Regional Medical Center
Volunteer Services
RECOMMENDATION FORM: Please return it to the applicant in a sealed envelope or mail or fax it to:
1324 Lakeland Hills Boulevard |
Office |
Lakeland, Florida 33805 |
Fax |
TO THE APPLICANT:
At Lakeland Regional Medical Center, our first concern is for our patients and their families. It is imperative that all who enter service as a volunteer appreciate the importance of respecting the rules and structures that govern us. Adult and Teen volunteers are required to comply with specific regulations to protect the safety and privacy of our patients. We ask for this letter of recommendation from a teacher, counselor, scout leader or other adult who can speak of your character and reliability and give us the confidence necessary to include you in our program.
_____________________________ is applying for the LRMC Teen Volunteer Program.
(Print applicant’s Name)
TO THE EVALUATOR:
In order to assist us in evaluating the applicant above for admission to the Lakeland Regional Medical Center Teen Volunteer Program, we would appreciate your responses to the
following questions. Comments, which may be viewed as other than positive, will not necessarily preclude a student’s admission to the program.
1.Please comment on the character, attitude and emotional maturity of the applicant.
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2.Does this student have the ability to work in an unsupervised situation?
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3.To your knowledge has the student had any disciplinary problems?
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4.Please comment on the strengths that you feel this student possesses.
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5. Please add any additional comments that you feel would be of assistance to the student or Volunteer Services.
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Name (please print):_____________________________________________________________
Signature: ____________________________________________________________________
Position/Title: __________________________________________________________________
Organization/School: ____________________________________________________________
Daytime phone: ________________________________________________________________