Thank you for applying to volunteer at Harris Health! As part of our intake process, we require documentation of the following vaccinations: measles, mumps and rubella (MMR); pertussis; and varicella (chicken pox). You may submit these documents in a pdf format to volunteer@harrishealth.org or fax to 713-440-5505. Please note that those born prior to 1957 are considered immune for measles, mumps, and rubella (MMR) and are not required to have this immunization, but all other vaccinations are required. Please feel free to contact our office via volunteer@harrishealth.org or 713-873-2227 should you have any questions or concerns related to these requirements. Thank you for your interest in volunteering at Harris Health!

Adult Volunteer Application

HARRIS HEALTH SYSTEM
Volunteer Location Choice

Please select the location of your choice:
Name prefix
First Name
MI
Last Name
Home Address
City
State
Zip Code
Home Phone
Cell Phone
Work phone
E-mail Address
Date of Birth
Gender
Ethnicity
Shirt Size
Marital Status
SS Number
Drivers Licence or ID#
State Issued
Language
Additional languages
EMERGENCY CONTACT INFORMATION
Contact name
Address
City
State
Zip Code
Home Phone
Cell Phone
Work Phone
E-mail

EDUCATION AND EMPLOYMENT INFORMATION
Highest Level of Education
School/Major:
Employment Status
Company Name
Current Job Title
Business Experience
VOLUNTEER INFORMATION
*Are you a returning volunteer?
Group Code:
Why would you like to volunteer with Harris Health?
Assigned by volunteer manager as needed.
Volunteer Experience
Volunteer Interest
Position Category
Length able to commit
Volunteer source

PHOTO RELEASE:
As a Harris Health volunteer, I realize that my image may be taken at hospital celebrations and other media events. I give my permission to the Harris Health System Director of Volunteer & Guest Services and the Administrative Director of Corporate Communications to use my image in any appropriate and related materials that will promote or otherwise publicize the Volunteer & Guest Services department or Harris Health.*
BACKGROUND CHECK AUTHORIZATION:
I authorize Harris Health System to conduct any and all inquiries necessary to determine my acceptability as a volunteer, including a thorough background check. I understand that this background check may include verification of personal and/or employment references, military information or police record inquiries.
Choose if you have ever been convicted of or been on defferred adjudication for, or are you now either awaiting trial for or on deferred adjudication for, a felony or misdemeanor.
List and explain convictions if any:
I am 18 years of age or older.
By checking this box I agree to have Harris Health System conduct a background check.
CONFIDENTIALITY AGREEMENT:
I agree to use confidential or proprietary information only as needed to perform my volunteer duties. This means I will not access confidential or proprietary information without legitimate need/permission, nor in any way divulge, copy, release, sell, lend, revise, alter, or destroy any confidential or proprietary information belonging to Harris Health System. I understand that I will be automatically dismissed as a volunteer if I do not respect my responsibility for maintaining confidentiality.
1. Understand that it is a crime to solicit business for attorneys and/or insurance companies.

2. Authorize Harris Health System to provide me with a yearly TB skin test as part of my volunteer service. Should I test positive, I understand that I must provide the Volunteer & Guest Services department with a letter from my physician stating that my TB is inactive before continuing my volunteer duties.

3. Am donating my services to the hospital district without expectation of compensation and am not to solicit employement while performing my volunteer duties.

4. Understand that the Volunteeer & Guest Services Department does not assign volunteers to areas of professional or medical confilicts of interest.

5. Will not sell or attempt to sell any goods or services, solicit monetary or in-kind contributions, or collect/distribute petition signatures on Harris Health System premises.

6. Understand that, I must never attempt to assess or diagnose any patients, nor shall I attempt to perform any medical procedures (i.e. draw blood, insert an IV and any other procedure that requires a medical license) on patients.

7. Understand that, I will be evaluated by the Volunteer & Guest Services Department , as well as, the department in which I have been placed. I also will be given the opportunity to evaluate the deparment and the volunteer duties that I have been assigned.

8. Understand that the Volunteer & Guest Services Department reserves that right to terminate my volunteer status as a result of:

- Failure to comply with Harris Health System, as well as, departmental policies, rules and regulations.
- Unsatisfactory attitude, work or appearance/attire.
- Habitual tardiness and/or absences.
- Any behavior deemed unacceptable by any Harris Health System facility, department supervisor and/or the Volunteer & Guest Services Department.

9. I understand that, I am responsible for returning my badge and uniform to the volunteer and the Guest Services Department after completing my volunteer services.
I HAVE READ ALL THE ABOVE STATEMENTS AND I AGREE TO ADHERE TO THEM.