If you would like to volunteer at Lakewood Ranch Medical Center, please fill out the application form below. The information you provide in this application must be true in all respects, without any willful omissions. If your application is false in any way, you will be dismissed without notice regardless of when the false information was discovered. By clicking "SUBMIT" you acknowledge that you have read and agree to the contract of confidentiality below.

If you have any questions, please call 941-782-2128​ or kristina.sparacino@lwrmc.com.

Contract of Confidentiality

As a volunteer, I understand that I may come in contact with confidential information, both clinical and employee related, through, but not limited to, written records, documents, ledgers, internal correspondence and communications, computer programs and applications. I agree not to divulge or disclose to anyone other than those persons of Lakewood Ranch Medical Center and/or its affiliates who have “need to know”, directly or indirectly, either during or after my services, any confidential information acquired during the course of my services. I understand and acknowledge that in the event I breach any provision of this agreement, Lakewood Ranch Medical Center, in addition to other legal remedies available to them, has the right to reprimand, suspend and/or terminate my volunteer service.

As a Volunteer, I:

  • Agree to attend the volunteer orientation and train until I am competent to perform the required duties
  • Agree to comply with all the rules and regulations of the hospital and the Volunteer Services Department
  • Understand that I may be dismissed from my duties for willful wrongdoing or negligence and/or performing duties outside my service guidelines
  • Agree to call my service area supervisor as soon as possible when I have scheduling changes
Personal Information
Full name (including middle initial)
How do you want your name to appear on your badge?
Address
Apartment or lot number
City
Zip code (nine-digit)
Local phone
Birthday (month/day/year)
Degree(s)
Current or last place of employment
Emergency Contact Information
Name
Relationship
Address
Home phone
Work phone
Physician
Phone
If other, please specify.
Comments
Department preference
What do you envision yourself doing as a volunteer?
If yes, please describe.
What about the healthcare setting appeals to you?
If you need special assistance to perform your volunteer duties, please indicate those needs here.
If other, please specify.
If yes, please explain. NOTE: Conviction of a crime is not necessarily grounds for disqualification.