Menu
Log in
 


  

Society for Healthcare

Volunteer Leaders

Log in

Jr. Volunteer Consent Forms

  • Wednesday, June 01, 2016 9:41 AM
    Message # 4051040
    Cindy Short (Administrator)

    We currently have a Parental Consent Form for the Urine Drug Screen for our Jr. Volunteers. Does anyone have a Parental Consent Form for TB Testing and Blood Draw for volunteers under the age of 18? 

  • Thursday, June 02, 2016 8:52 AM
    Reply # 4053442 on 4051040
    Deleted user

    We require parent consent as well as the parent must be with the teen for the urine drug screening and stick portion of 2 step TB skin test. We do not require a blood draw.  

  • Tuesday, June 28, 2016 8:05 AM
    Reply # 4105610 on 4051040

    We do not do urine test on any volunteers. Only the two step PPD is required and an adult over 18 must be with the teen when this is done.


  • Tuesday, June 28, 2016 2:22 PM
    Reply # 4106142 on 4051040
    Deleted user

    We do not do drug tests and we do not offer TB tests to our teen volunteers.  We do have a parent consent form for volunteer which I have copied below.

    Volunteer/Job Shadow Parent Consent and Release of Liability Form

    If volunteer/shadower is under of the age of 18, parental guardian consent is required.

     

    My son/daughter, _______________________, has my permission to serve as a KentuckyOne Teen Volunteer and/or participate in the KentuckyOne Health Job Shadow experience.   As the parent/guardian of the above-named student, I will read the literature that is provided to my child so that I know what will be expected of him/her. 

     

    I attest that my child is at least 14 years of age (Volunteer Program) or 16 years of age (Job Shadower Program) and is free from communicable diseases and will be able to provide evidence of negative TB screening and proof of immunization (signed by licensed nurse or healthcare provider), immunity by laboratory results (positive titre), or natural disease history (diagnosed, documented, and signed by licensed healthcare provider) of rubella (German measles), rubeola (measles), and varicella (chicken pox) within 24 hours of request by hospital personnel. 

     

    Volunteering and/or Job Shadowing may include observing patients in a healthcare setting and observing medical, laboratory, and/or business procedures.  I further understand that KentuckyOne Health offers medical services for the care and treatment of a wide range of illnesses, diseases and injuries, including but not limited to, such infectious diseases as tuberculosis, hepatitis, and HIV and that there is a risk, however slight, that my son/daughter might be inadvertently exposed to such diseases at the Hospital.

     

    I do hereby release KentuckyOne Health, their staff and sponsors from any responsibilities of injury or accident as a result of the volunteering/shadowing experience.  Any medical expenses incurred as a result of injury or accident will be my responsibility.

     

    I understand that in case of a medical emergency, every attempt will be made to contact me before medical action is taken.  However, this document is my consent as parent or guardian for emergency treatment and/or procedures necessary for my son/daughter by the professional staff at KentuckyOne Health.

     

    I release, discharge and relieve KentuckyOne Health from any and all claims whatsoever of any nature as a result of his/her volunteering/shadowing and all related activities.

     

               

     

     

    ___________________________________________________ Date_________________________

    Parent/Guardian Signature

  • Wednesday, June 29, 2016 11:26 AM
    Reply # 4107280 on 4051040
    Deleted user

    We do not do a blood test or urinalysis on teens. We do a review of their immunization records and a TB screening form. Their parent or guardian must be present for this review in order for them to be cleared. The teen does not need to be present.

  • Thursday, June 30, 2016 10:34 AM
    Reply # 4109052 on 4051040
    Deleted user

    Since we have a no nicotine policy, we do a urine screen.  You would be surprised that teens don't think they will be caught for such and worse.  We don't do a background check because those records are usually sealed by the court system.

    Our form:

    Parental Consent for a Minor to Participate in the  Volunteer Program

     My signature at the bottom of this form signifies that I agree and understand to all of the conditions and processes for my teen to become a volunteer at Children’s of Alabama.

    ·        My teen must be 16 before making application to the program, and will be able to complete the minimum requirement of 3 hours one day a week for a minimum of 16 consecutive weeks.  If there is a one week vacation or sick period, then the number of weeks will be extended until the teen has completed a minimum of 48 hours of service.  Of course the teen can continue serving beyond the minimum if so desired.

    ·        As a part of the teen program requirements, my teen will receive a TB skin test annually.  I understand that this is an invasive procedure and that my teen must return for the test to be read two days after the test is administered.  The only exception is for someone who always tests positive and medical documentation must be presented – letter from physician or health department or Chest X-Ray.

    ·        I also understand that an annual flu shot is required and documentation must be on file in the Volunteer Services Department.  NOT FLU MIST.  Depending on when the teen starts, it may be required immediately, or may be required in the fall of the year.

    ·        I understand that as a volunteer in a hospital setting there is a slight risk that my teen may be exposed to an infectious disease.  Precautions will be discussed as a part of the orientation process, but as there is for all employees, there will be a risk and I agree to hold Children’s of Alabama harmless in case of exposure.

    ·        I understand that as a part of the teen application process that Children’s of Alabama or a third party will conduct a pre-placement screening.  A part of this screening is to enforce the no nicotine use policy of employees and volunteers at Children’s.  Furthermore, I understand that such information may be released to any person, including but not limited to local, state, national licensing and accreditation organizations, to whom the Chief Human Resource Officer or Designee may determine it necessary to disclose information for any purpose not prohibited by law.  I hereby waive any claim or cause of action I may have against Children’s of Alabama and/or any of its officers, directors, employees, agents and/or attorneys related to the release of this information regarding prescreening.  I understand that any information released to Children’s of Alabama will be used to determine whether my teen is fit to perform the duties of a Volunteer.

    ·        This completed form must be brought to the interview appointment or the teen will not be accepted into the program.

    _____________________________________________              __________________________                          Please Print Teen’s Name                                                               Teen’s Date of Birth

    _____________________________________________      __________________________                              Legal Guardian/Parent Signature                                                    Today’s Date                                  

     

Have Questions?

Contact us at shvl.email@gmail.com

Powered by Wild Apricot Membership Software