MyImpactPage - Animal Assisted Therapy Application Form

Animal Assisted Therapy Program Requirements

Thank you for your interest in volunteering at NCH!

Please acknowledge and agree to the following before completing the application:

I am 18 years or older (not in high school)
I understand that completing this application does not guarantee me a volunteer assignment.
If I'm selected and qualified, I will be invited to have my dog's temperament tested/evaluated ($30) and required to provide a portion of the costs for the training program ($125)
Applications will be considered on a rolling and as needed basis. We hold applications for one year and consider applicants as our needs change.
I understand as a condition of initial and continued participation in the volunteer program I agree to complete:
- Online volunteer orientation
- A background check
- All health requirements as determined by NCH's Employee Health department
If accepted I will offer my services without monetary compensation
If accepted I agree to comply with all the hospital’s rules and regulations, and those specific to the volunteer services department.

Please Note - the application allows you 30 minutes to input in all of your information, including a photo of your ID. Information can not be completed in multiple sessions. It must all be completed at one time.

I am new to MyImpactPage.com

You will need to enter a unique username to identify yourself to the system. You should select something that is easy for you to remember such as your email address or your name. Your username must be at least 6 characters long. If the name you enter is already in use by someone else, you will be prompted to choose another username.

Username

Required

	Username must not start with space
	Username must not end with space
	Username must not have two or more spaces in a row

Email Address

Required

Verify Email Address

Required

I agree to the program requirements above. Required

I already have a username

If you have signed up with this organization before, or are a member of another organization that uses MyImpactPage.com, you can use the same login to access all organizations with which you are associated.

Username	Required
Password	Required
Forgot your username or password?
I agree to the program requirements above. Required

Already use MyImpactPage.com to volunteer with this organization? Go to volunteer login

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