Welcome to Corewell Health Volunteer Services

If accepted as an Ascension Mercy Hospital Volunteer, I agree that:
1. I understand that my services are voluntarily donated to Ascension Mercy without expectation of compensation or future
employment.

2. I understand that I am committing to volunteering a minimum of 6 months. I am expected to report as scheduled and
follow the procedures for attempting to find a substitute, if required, for my volunteer position.

3. After a three (3) month orientation period, I agree to be reviewed by the department designee to evaluate if my placement is in the best interest of myself and the department. Thereafter, periodic reviews may be completed to evaluate my volunteer
performance.

4. I understand that final documentation of service hours will not be verified and reference or recommendation letters will not
be given in the event I volunteer less than 6 months or less than 50 hours.

5. I authorize a Criminal and Health Care Background check, a Health Care Sanction and reference check and understand
that information received from this application will be used for determining my eligibility for volunteering.

6. I will submit to the required health screenings which include seasonal influenza immunization (flu shot) or approved
declination, and a blood draw to test for TB and immunities to measles, mumps, rubella and varicella (chicken pox). I
authorize any initial and future screening required by Ascension Mercy and understand my volunteer assignment is
contingent upon successful completion of all screenings.

7. I understand and agree to comply with the policy of Ascension Mercy Hospital which requires seasonal influenza
immunization on an annual basis to all associates/volunteers in accordance with the Center for Disease Control and
Prevention (CDC) guidelines.

8. I agree to attend periodic in-services. Federal and health care accreditation agencies require in-services for all volunteers
to maintain consistent performance levels. These in-services provide training, updates, and interaction with department staff.

9. I shall, always, uphold the mission, values and standards of behavior for Ascension Mercy and the Volunteer Services
Department.

0. I understand that the Volunteer Services Department reserves the right to terminate my volunteer status as a result of:
(A) failure to comply with policies, rules and regulations; (B) absences without prior notification; (C) unsatisfactory attitude,
work or appearance; (D) any other circumstances which, in the judgment of the department manager, would make my
continued services as a volunteer contrary to the best interests of Ascension Mercy.

11. I release from any and all liability all representatives of Ascension Mercy for their acts performed in good faith and
without malice in connection with evaluating my volunteer application. I further authorize any party having information
bearing upon my qualifications to release such information to Ascension Mercy and also release any party from liability in
sharing this information with Ascension Mercy. I also authorize Ascension Mercy to release similar information to prospective
employers.

12. Should I become ill or sustain an injury while volunteering, if under legal guardianship and if my guardian cannot be
reached, my guardian authorizes medical care and treatment. Guardian signature required. If volunteer applicant is under
age 18 or under legal guardianship. See website to print this volunteer agreement form for signature.

I have reviewed, understand and agree to the above conditions. I certify that my statements in this application are true and
complete and I authorize investigation of the statements I have made. I understand that falsification of this application constitutes grounds for rejection or termination from the volunteer program.