Ronald McDonald House of Southwest Virginia

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Family Room at Carilion
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Family Room Volunteer Application

This application is to volunteer at the Ronald McDonald Family Room (located inside Carilion Children's Hospital)*
- I understand! This is where I want to volunteer
- Oops! I meant to apply to be a Ronald McDonald House Volunteer instead
If you meant to apply to volunteer at the Ronald McDonald House, go back to the last page and select "Sign Up" under House Volunteer.
Name*
First Last
Birth Date*
MM slash DD slash YYYY
Gender
Address
Street Address City State ZIP Code
Personal Phone*
Email*
Preferred Method of Contact*
How would you prefer that we contact you in response to your application?
How did you find out about Ronald McDonald Family Room?
Occupation?
Current Employer
Employer Address
Street Address City State ZIP Code
May We Contact Your Employer?
- Yes
- No
Work Phone
May We Contact You At Work?
- Yes
- No
Reference #1
First Last
Phone
Address
Street Address City State ZIP Code
Reference #2
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 Days of the Week:
- I'm flexible- whenever you need me the most!
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
- Sunday
Preferred Time of Day
- I'm flexible- whenever you need me the most!
- 9:00 am - 12:00 noon
- 12:00 noon - 3:00pm
- 3:00pm - 6:00pm
- 6:00pm - 9:00pm
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, criminal background check, and a flu shot. 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 Mon - Fri 8:00am - 5:00pm Donation Hours 7-days a week: 8:00am - 8:00pm (Outside Drop Off Option Available)

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 Keeping families close.

RMHC-SWVA is recognized as a public charity under Internal Revenue Code section 509(a) and has 501(c)(3) status. Donations to RMHC-SWVA are deductible. Donors should consult their tax advisor for questions regarding deductibility. A copy of the RMHC-SWVA determination letter is available upon request.

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