Ronald McDonald House of Southwest Virginia

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Family Room at Carilion
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Family Room Volunteer Application

Name*
First Last
Email*
Phone*
Address
Street Address City State ZIP Code
Birth Date*
Gender
If Other, Please Specify
How did you find out about Ronald McDonald Family Room?
Occupation?
Employer
Employer Address
Street Address City State ZIP Code
Work Phone
May We Contact Your Employer?
- Yes
- No
May We Contact You At Work?
- Yes
- No
Reference:
First Last
Phone
Address
Street Address City State ZIP Code
Reference:
First Last
Phone
Address
Street Address City State ZIP Code
Please describe what you consider an ideal volunteer job for you at this time (position, expectations, etc.) Why?
Special skills, training, and interests you would be willing to share in your work:
Please list previous volunteer experience. Include the organization, activities performed, and dates volunteered.
Preferred Times of Day:
(3 hour shifts starting at 9am, 12pm, 3pm & 6pm)
Preferred Days of the Week:
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
- Sunday
Is it necessary to limit your physical activity in any way?
- Yes
- No
If yes, please explain.
Emergency Contact Information
First Last
Relationship
Address
Street Address City State ZIP Code
Home Phone
Work Phone
Carilion Clinic Childrens Hospital requires that you complete their volunteer orientation as well as have a TB test, drug screening, and criminal background check. Are you willing to complete these requirements?
- Yes
- No

Ronald McDonald House Volunteer Application Form Thank You

Ronald McDonald House of Southwest Virginia

Office Address 2224 Jefferson Street SE
Roanoke, Virginia 24014 Get Directions

Office Hours 7 Days a Week: 8am – 8pm Donation Hours 7 Days a Week: 9am - 8pm

Office Phone 540.857.0770 Office Fax 540.857.9584

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^© RMHC The following trademarks used herein are owned by McDonald's Corporation and its affiliates; McDonald's, Ronald McDonald House Charities, Ronald McDonald House Charities Logo, RMHC, Ronald McDonald House, Ronald McDonald Family Room, and Ronald McDonald Care Mobile. Ronald McDonald House Charities of Southwest Virginia 2224 South Jefferson Street, Roanoke, VA 24014 Office: (540) 857-0770 Family Room Phone: (540) 981-7471 Fax: (540) 857-9584 Email: info@rmhouse.net Ronald McDonald House Charities of Southwest Virginia is a 501(c)(3) non-profit organization.

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