VOLUNTEER APPLICATION FOR LIFECARE CENTER EAST
FULL NAME __________________________________________________________________________________________________
DATE OF BIRTH __________________________________________________________________________________________________
COMPLETE ADDRESS
__________________________________________________________________________________________________
PHONE (DAY)
__________________________________________________________________________________________________
(EVENING)
__________________________________________________________________________________________________
OCCUPATION
__________________________________________________________________________________________________
MARITAL STATUS
__________________________________________________________________________________________________
NAMES AND AGES OF YOUR CHILDREN __________________________________________________________________________________________________
__________________________________________________________________________________________________
PREVIOUS VOLUNTEER EXPERIENCE
LIFECARE CENTER EAST POLICIES
1) Every individual has the right to life and the right to health care from the moment of conception until natural death.
2) Total Life-Care Centers and its Affiliates do not perform abortions, nor refer for abortions, but offer alternatives to meet the physical, emotional and financial needs of all concerned.
3) We promote fertilitiy awareness and education regarding the consequences of contraception because we care about
the health of women, men, and children. Artificial birth control methods and sterilization are incompatible with the Life
Care philosophy and shall not be encouraged, provided, or dispensed.
4) We promote chastity and sexual abstinence for single people. We promote chastity and natural family planning for
married people.
5) No one will be refused services because of inability to pay.
6) Doctors and other medical professionals who are participating with any Life Care Center must follow the above
policies and practices.
Are you in agreement with all of these policies?
Yes________ No________
Comments __________________________________________________________________________________________________
__________________________________________________________________________________________________
Do you agree to promote these policies while you are volunteering at LifeCare Center East?
Yes________ No________
ANY VOLUNTEERS WHO ARE SPECIFICALLY INTERESTED IN VOLUNTEERING
AS A MENTOR MUST PROVIDE THEIR SOCIAL SECURITY NUMBER AND SIGNATURE
BELOW FOR PURPOSES OF PERFORMING A BACKGROUND CHECK.
Social Security #
__________________________________________________________________________________________________
Signature:
__________________________________________________________________________________________________
AND TRAINING HAVE YOU HAD THAT WOULD BE USEFUL TO YOU AS A VOLUNTEER?
__________________________________________________________________________________________________
__________________________________________________________________________________________________
WHAT ARE YOUR THOUGHTS AND FEELINGS ABOUT:
TEENAGE MOTHERS __________________________________________________________________________________________________
__________________________________________________________________________________________________
ABORTION IN CASES OF RAPE, INCEST FETAL DEFORMITY
__________________________________________________________________________________________________
__________________________________________________________________________________________________
A WOMAN WHO HAS HAD AN ABORTION
__________________________________________________________________________________________________
__________________________________________________________________________________________________
ADOPTION __________________________________________________________________________________________________
__________________________________________________________________________________________________
HAVE YOU EVER HAD ANY EXPERIENCES WITH ABORTION?
__________________________________________________________________________________________________
PLEASE EXPLAIN
__________________________________________________________________________________________________
__________________________________________________________________________________________________
WHAT ARE SOME QUALITIES OF A GOOD MOTHER?
__________________________________________________________________________________________________
__________________________________________________________________________________________________
