Volunteer Application

 

The mission of Panama Hospice and Respite Foundation is to provide essential services to the dying or those suffering a period of temporary disability or illness, and support to their families.

 

If you would like to join this volunteer organization, please fill out the form below. Membership is not automatic but must be approved by the Foundation Board.

 

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I am willing to be an active member of this group by doing the following (please check all those that apply):
Delivery of items from hospice loan cupboard
Preparing meals for a patient
Helping patients with tasks such as grocery shopping, running errands, paying bills, walking pets, etc.
Visiting homebound patients or providing relief to care givers
Making a monetary donation. Please make checks payable to Panama Hospice and Respite Foundation (PHRF)
Helping with publicity for the Foundation
Helping with fundraising for the Foundation
Helping with administrative tasks for the Foundation, such as filing, typing, running errands, etc.
Researching issues impacting the Foundation or its clients
Other, please specify:
   
   
Please describe any prior experience, if any, with hospice or providing health care:
Please provide two (2) personal references below who are not family memebers :
Reference # 1  
Name: Required data
Address: Required data
Phone #: Required data
Email Address: Required data
Reference # 2  
Name: Required data
Address: Required data
Phone #: Required data
Email Address: Required data

I am willing to take the basic orientation program from the Panama Hospice & Respite Foundation:

   Please make a selection.

I understand that a cornerstone of providing hospice and health care support is to keep all matters confidential, and I agree to do so.

   Please make a selection

   
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