Application for Pastoral Care Volunteer

Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone Number
Birthday
Month
Day
Year
Email
Contact in Case of Emergency
First Last
Emergency Contact Relationship (ie Spouse, Parent etc.)
Emergency Contact Phone Number
Volunteer Experience
Work Experience
What is your reason for volunteering?
Do you have any relatives employed or volunteering at Mather Hospital?
- Yes
- No
Please provide information
References
Please provide two references. One reference must be from a clergy person. The other reference may be from among the following: clergy person, employer, former employer, or an adult volunteer at this facility.
Reference #1 - Name
First Last
Reference #1 - Phone Number
Reference #1 - Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Reference #2 - Name
First Last
Reference #2 - Phone
Reference #2 - Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Please check if you are representing the following
- Eucharistic Minister
- Christian Faith
- Muslim Faith
- Judaism
Please Enter Your Initials Below*
Date: 10/01/2026
Opportunities for volunteers are provided without regard to race, color, sex, age, creed/religion, national origin, alienage or citizenship status, marital status, sexual orientation, gender identity, gender expression, genetic predisposition or carrier status, partnership status, victim of domestic violence disability, military/veteran status, or other characteristics protected by applicable law.

Application for Pastoral Care Volunteer

References