Volunteer’s Particulars Form

Join us as a Friend of Khoo Teck Puat Hospital!

i NOTE: All information given will be treated in strict confidence. Please submit completed form via , (a) Email: or (b) Mail : 90 Yishun Central S768828

Volunteers must be above 21 years old and able to commit regularly for a minimum of six months.

1 PERSONAL PARTICULARS

Full Name (please underline surname)
* Dr/Mr/Mdm/Ms / Contact Details
Handphone:
Home:
Email:
NRIC/FIN/Passport No:
Nationality: * Singapore/PR/Other : ______/ Contact Address (Home)
Date of Birth:
Marital Status: * Single/Married/Other :______
Race: / Age:
(Volunteer should be at least 21 yrs old)
Sex: *Male/Female
Religion: / Language(s) spoken:
English
Mandarin
Malay
Tamil / Dialect(s):
Teochew
Hokkien
Cantonese
Pl specify:
------
Occupation:
Students pls state name of school/course:
If you are under 16 years of age, parental consent is required. Please be informed that you would only be allowed to volunteer in hospital events which are conducted on an ad-hoc basis.
Name of Parent / Guardian:
Contact No:
In case of emergency, person to contact:
Name:
Relationship:

2 HEALTH CONDITIONS AND DECLARATION

1. Do you suffer from any physical impairment or disease including mental illness, deafness, handicap, hypertension, diabetes, heart disease? If yes, please specify:
Are you a Hepatitis B Carrier? / Yes
Yes / No
No
2. Have you ever been convicted in Court for any wrong doing?
If Yes, please elaborate: / Yes / No
3. Have you volunteered with any other organisations?
If Yes, please elaborate: / Yes / No

3 Please state any skills or expertise that you can contribute to Khoo Teck Puat Hosptial:

Office/Graphic Software Skills [Eg. Microsoft Office, Photoshop, Windows Movie Maker]
Leisure Crafts [Eg. Painting, photography, gardening, ceramics]
Others [Eg. Ability to play musical instrument, public speaking]

4 EXPERIENCE IN VOLUNTARY WORK (if applicable)

Organisation / Period of service / Briefly describe type of voluntary work performed / Name of reference

5 AREA(S) OF INTEREST

Please rank the top 5 volunteer activities you are interested in, in order of preference (1-most preferred, 5-least preferred). You need not rank those options which do not interest you.

Rank / Volunteer Programme / Description / Timing
Activities Around The Hospital
Patient Greeters / Help us extend a warm welcome to visitors and assist them with directions to the desired clinics / offices / wards. / Weekdays during office hours, at least 2 hrs per session, timing flexible.
A&E Care Corner / Ease the anxiety of relatives whose loved ones are in the restricted A&E observation area. Provide updates and help answer queries about the admission process. / Any day of the week, timing flexible, 2 hrs per session.
Contact Centre CALL-eagues / Assist our call centre with administrative duties such as data entry. Must be familiar with computer programmes such as Microsoft. / Weekdays during office hours, at least 2 hrs per session, timing flexible.
Gardening Club / Create a healing environment for our patients by tending to our gardens and organic rooftop vegetable farm. / Weekdays and Saturday mornings, at least 2 hrs per session. (dependent on weather)
ABLE Studio Ambassador / Help our patients transition from hospital to home. Chat with patients and caregivers to provide useful product information and home care tips. / Any day of the week, at least 2 hrs per session, 10 am to 2pm.
Patient Related Activities
Dementia Care / Socialise with the elderly patients in the ward, chit chat with them on their past. Volunteers can accompany the patients for a walk to the gardens. Fluency in dialects and/or foreign languages essential. / Weekdays, at least 2 hrs per session, 2.00pm – 5.00pm.
Inpatient Mobile Library Team / Share the joy of reading with our inpatients by brining our mobile library of reading materials to them. Chat or read with our patients to share some cheer and help them recover quickly! / Any day of the week,
10 am – 12 noon or
2.30 pm – 4.30 pm
Patient Ambassadors @ A&E / Allay the anxiety of patients at the A&E. Help them with registration and answer simple queries. Fluency in dialects and/or foreign languages essential. / Any day of the week, at least 2 hrs per session, timing flexible.
Events & Logistics
Logistics/ Administration / Support the admin and operations departments through tasks such as data entry and database management, design of publicity materials, placement of posters and signage for various events, wrapping corporate gifts, packing corporate collaterals etc. / Weekdays and Saturdays, at least 2 hrs per session, timing flexible, depending on the event.
Health For Life events / Assist our Health for Life Clinic with registration, crowd control and data entry during health screening events and public forums. / Timing flexible, dependent on event.
Material Management Team / Assist in data entry, picking and topping up of store supplies in various locations in the hospital, and assembling of wound dressing packages. / Weekdays during office hours, at least 2 hrs per session, timing flexible.
Other Areas of Interest / Please Specify :


6 AVAILABILITY

Ad Hoc (Please be informed that you would only be allowed to volunteer in hospital events

which are conducted on an ad-hoc basis.)

Please specify [Eg. School Holidays, Project Basis etc.] : ______

Regular (Volunteers must be able to commit for at least six months to be able to join our

main-stream volunteer programmes.)

Time Frames: Preferred day(s): ______

Weekly Basis

Bi-weekly Basis ______

Monthly Basis

Session Length: Preferred time(s): ______

2 – 4 hours

5-6 hours ______

More than 6 hours

7 Please describe why you are inspired to volunteer at Khoo Teck Puat Hospital.

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I certify that the above information is true and complete. I agree to abide by all Hospital policies, regulations and procedures. [Signature is not required for emailed application.]

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Applicant’s Signature Date

Touching Lives, Pioneering Care, Making A Difference