Hospice of the Piedmont, Inc. accepts volunteers without discrimination on the ground of sex, race, color, national origin, or creed. No otherwise qualified individual shall solely by reason of his/her handicap, be excluded from participation as a volunteer.

Agreement: I certify that answers given herein are true and complete to the best of my knowledge. I authorize you to make such investigations and inquiries of my personal employment, medical history, police record, and other related matters as may be necessary in arriving at a decision about volunteer placement. I hereby release employers, schools and other persons from all liability in responding to inquiries in connection with my application.

By typing your name below, you are electronically signing this application and confirming the statement above.