Welcome to Trinity Health Ann Arbor, Chelsea, and Livingston Volunteer Services.
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Summer Teen Application
Teen Application 2025
Today's Date
Personal Information
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First name
Group
Summer Teen
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Middle name
*
Last name
*
Address
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City
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State
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Zip/postal
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Mobile
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DOB
Gender
*
E-mail
*
Emergency Contact Name
*
Emergency Contact Phone Number
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Relationship
Parent/Guardian E-mail
*
Hobbies, Skills, Special Interests, Computer Programs:
In the space below, please state why you are interested in volunteering at THAA and what you hope to gain from this experience
Have you ever been convicted of anything other than a minor traffic citation, or are there felony charges outstanding?
Yes
No
If yes, please list dates, places, charges, and deposition of all convictions:
Experience
Do you have experience as an volunteer?
Yes
No
If yes, please identify:
Education
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School currently attending
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Current Grade
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Select role you are interested in volunteering in: Welcome or Bookcart Ambassador
Availability
You should be able to work a typical four hour shift for eight consecutive weeks as listed below, please indicate what your availability is during the day. (Check all that apply)
8 am to 12 pm
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
12 pm to 4 pm
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
4 pm to 8 pm
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
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Dates available to start volunter work
*
Last Day available to volunteer
Select the location(s) you are interested in volunteering at:
Livingston or Brighton
Ann Arbor
Chelsea
* Maximum of 2 absences *
Dates you will be absent due to vacation, band/sports/church camps, etc.
Select a date for orientation.
Orientation
Volunteer Uniform
Shirt Size
I certify that the responses on this document are true to the best of my knowledge. I agree that this information may be verified and references contacted by Trinity Health Syetem. Misrepresentation of facts constitutes separation from Volunteer services. I agree to abide by all Trinity Health System rules and regulations including rules requiring that patient information be kept confidential. It is further understood that the Volunteer Services Department is not obligated to provide a placement, nor am I obligated to accept the postiton offered.
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Signature
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Date
Parental Consent For Teen Volunteers
*
I approve of my daughter/son
Volunteering her/his services at Trinity Health System and will endeavor to see that the pledge in regard to attendance, hours of service and duties fulfilled. Volunteers commit to work 4 hours per week for eight straight weeks from June through August. Teens are expected to make up any absences. At our volunteer orientation session we cover the duties and responsibilities of volunteer services at Trinity-Health System. In addition we also explain the benefits the students will gain through their community service. If you have any questions regarding our program please do not hesitate to contact us. I verify that my daugther/son is at least sixteen years old and will be available to volunteer on a weekly basis beginning June through August.
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Signature
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