Skirball Hospice

A Program of the Los Angeles Jewish Home Providing Hospice and Palliative Care

Call 877.774.3040

Volunteer Application Form

If you have a passion for providing a higher quality of life for Skirball Hospice patients and their families, we have a myriad of ways for you to share your time and your talents. Please fill out the form below and someone from our Volunteer Department will contact you.

For a printable version of this form, please click here.

Items that are required are marked with an asterisk (*).

Contact Information
 *
 *
 *
 *
 *
 *
 *
 *
Experience



Daytime:
Evenings:
Weekends:
Other:

:
High School   2 Year College   4 Year College   Post Grad





(Optional—this assists us in proper placement of our volunteers. We serve patients regardless of religious affiliation).
Catholic   Protestant   Jewish   Other   
Personal Information:









Yes   No




Yes   No 







Yes   No

Yes   No

(Auto insurance is required if you use your car for hospice work)
Yes   No
(Conviction will not necessarily disqualify you from volunteering.)
Yes   No

Areas of Interest:

(please check areas of interest)

Patient and/or family visits Meal preparation Shopping/run errands
Relieve primary caregiver Read to patient Homemaking chores
Transportation Write letters Child care
Bereavement follow-up
Speakers bureau Sewing/crafts Computer work
Office assistance Videotaping Music or entertaining
Host/hostess for hospice events Photography Mass mailings
Third Parties


In Case of Emergency:
The Los Angeles Jewish Home