Youthful Horizons Therapy, Physical Therapy in Spokane Valley, WA

Youthful Horizons Therapy

OFFICE
325 S. University   Spokane Valley, WA 99206
Map / Driving directions
(509) 921-9798

Orthopedic therapy services Spokane, WA

Observer / Volunteer Information Form

Please complete this form and then Submit. This form will be submitted directly to the Coordinator.

Subject *
E-mail Address *
First Name *
Last Name *
Street Address
Street Address 2
City
State
Zip Code
Phone Number *
I am currently in: * High School
High School Graduate
College
College Graduate
Other, specify below
Please list which High School, College, or Other here

Experience Request:  Please enter as much information as possible to assist us with proper placement.
Observers shadow therapists as they treat children and adults.
Volunteers help staff with projects and may have opportunities to observe therapists.

Type of experience requested: *Job Shadow / Observation
Volunteer Request
Department for Job Shadow / Observation: *Pediatric Physical Therapy
Pediatric Occupational Therapy
Pediatric Speech Therapy
Orthopedic Physical Therapy
Name of staff member already contacted, if any:
Experience objective: *

Availability:  Please be as specific as possible

Mondays – Hours: *
Tuesdays – Hours: *
Wednesdays – Hours: *
Thursdays – Hours: *
Fridays – Hours: *
Requested beginning date: * Select Date
Approximate date(s) experience needs to be completed: *
Approximate total time needed (in hours): *
Please list previous job shadow / observation experiences:
Please list previous volunteer experiences:
Please list prior work experiences:
Please list interests: (hobbies, skills, special interests)
Have you ever been convicted of a crime? *Yes
No
If yes, explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s) imposed, and type(s) of rehabilitation.

Emergency Contact Information

Full Name *
Relationship *
Contact Phone Number *

Verification Code:
Enter Verification Code: *

* Required   
 

Confidentiality Agreement:

Individuals accepted for job shadow or volunteer experiences will be asked to sign a Confidentiality Agreement. All information you receive while in our facility is confidential and not to be disclosed without the appropriate consent by Youthful Horizons. Any breach of confidentiality will result in termination of your experience.