Please review the application process before filling out this form.
You may also print out the application in PDF format. (Confidentiality Agreement & Authorization to Release Information included. Mailing address is also in the pdf.)
Junior volunteers - go to this form.
It is a Mid Coast Hospital policy that all volunteers born after December 31, 1956, are required to show proof of their MMR immunization. All non-immune volunteers will be required to be immunized against the disease at no charge, in the Employee Health Department. Immunization date: (enter 'none' if none)
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