Jacob’s Heart Volunteer Application

We have many opportunities to volunteer for our September Childhood Cancer Awareness Month celebrations.  Volunteerism is the backbone of Jacob’s Heart. The information on this form will be entered into our confidential volunteer database. We organize our volunteers by interest, special talents and availability. We have volunteer opportunities for individuals, school groups and companies. Thank you for your interest in Jacob’s Heart Children’s Cancer Support Services. If you have any questions, please fill out this form or call us at 831-724-9100. Welcome to the Jacob’s Heart “Family of Families.”

* Required

 Yes No

Include information about company matching and how we can contact your employer.

 Daily Weekly As needed Other

Who should we contact in case of emergency? Please include address, phone, email and relationship to you

What do we do? What is our mission?

Specific training is available and required for each volunteer activity.
 General office - answering phones, data entry, office maintenance, etc. Kids Cards - making cards for children with cancer and their siblings (see instructions and training video) Respite and childcare for families (background check and training is required) Grocery delivery angel Fund raising - host or participate in events Family events - Kidrageous, Art from the Heart, Sibling Day, etc. Community Awareness - gold ribbon campaign, event booths, speaking (special training required) Adopt-a-Family Change of Heart Hospital or home visits Other:

 Yes No Other:

MorningAfternoonEveningVarious times
Monday Morning Afternoon Evening Various times
Tuesday Morning Afternoon Evening Various times
Wednesday Morning Afternoon Evening Various times
Thursday Morning Afternoon Evening Various times
Friday Morning Afternoon Evening Various times
Saturday Morning Afternoon Evening Various times
Sunday Morning Afternoon Evening Various times

Are you able to pay $25 for a background check?

Yes No 

 Newspaper My school or work Friends I have a personal experience with cancer Facebook Online search Other:

On a scale of 1 to 5, with 5 being a native speaker
No Spanish 1 2 3 4 5Native speaker

Yes No Friend or colleague has received services 


Yes No 

Confidentiality is of the utmost importance to the families supported by Jacob’s Heart Children’s Cancer Support Services and it is expected that anyone who works or volunteers for Jacob’s Heart Children’s Cancer Support Services understands this and agrees to abide by the following policy: I agree to respect the privacy of all families served by Jacob’s Heart Children’s Cancer Support Services. I understand that I may have access to confidential information, both verbal and written, relating to families, volunteers or staff of Jacob’s Heart Children’s Cancer Support Services. I agree to maintain confidentiality with regard to names, circumstances and services provided to the families served by Jacob’s Heart Children’s Cancer Support Services. I understand, and agree, that all such information is to be treated confidentially and discussed only within the boundaries of my volunteer position at Jacob’s Heart Children’s Cancer Support Services. No information is to be imparted to any person, group, or media representative, without prior approval of the Executive Director, except where such disclosure is consistent with stated policy and relevant legislation. I further understand that breach of this agreement shall constitute grounds for and may result in termination of my volunteer status with Jacob’s Heart Children’s Cancer Support Services.

 Please check that you have read the statement above. Please check if you agree to the statement above.


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