Volunteer Form

Date
MM slash DD slash YYYY
Referred to St. Mary's By
- Self
Name*
First Name Last Name
Address
Home Phone
Cell Phone
Email*
Date of Birth
MM slash DD slash YYYY
Are you over the age of 16?
Please Note: We only accept volunteers ages 16 and above.
- No
- Yes
Are you volunteering to meet School Requirements?
- No
- Yes
Current School Status
- 9 (Freshman)
- 10 (Sophmore)
- 11 (Junior)
- 12 (Senior)
- College
Name of School:
Address
Service Learning Instructor Name
Service Learning Instructor Phone
Program Start Date
MM slash DD slash YYYY
Program End Date
MM slash DD slash YYYY
Required Number of Hours
For All Applicants
Do you have any experience working with children?
- No
- Yes
If Yes, what?
Do you have any previous volunteer experience?
- No
- Yes
If yes, where and what?
Why would you like to volunteer at St. Mary's?
Have you been a patient or do you know a patient at St. Mary's?
- No
- Yes
If yes, explain
What dates and times are you available to volunteer?

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(718) 281-8800 | info@stmaryskids.org

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St. Mary’s Hospital for Children

29-01 216th Street
Bayside, NY 11360
Telephone: (718) 281-8800

St. Mary’s Preschool

Queens Borough President Helen Marshall
Early Education Center
Telephone: (718) 281-8848

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Telephone: (718) 281-8541

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Telephone: (516) 621-2681

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