I understand that the information provided in this application to volunteer with Weinstein Hospice is part of the volunteer permanent file. This information will be kept confidential and only be used to assist Weinstein Hospice in completing its volunteer screening process and in making the best possible match between me and a patient and/or assignment with the hospice.

I also understand that if I am accepted as a volunteer, I am committed to attending volunteer education and training sessions provided by the hospice and to abiding by the Policies and Standards of Practice of Weinstein Hospice.

I hereby certify that all information included in this application form is true and complete. I give permission to an authorized hospice representative to conduct reference checks with the above named referees and to submit my name for a criminal history background check with the state of Georgia.