Today's Date:
*
MM
DD
YYYY
Name:
*
First Name
Last Name
Date of Birth
*
MM
DD
YYYY
Address Line 1 (Street Address):
*
City:
*
State/Territory:
*
Select One...
AL
AK
AZ
AR
AS
CA
CO
CT
DE
DC
FL
GA
GU
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
MP
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
TT
UT
VT
VA
VI
WA
WV
WI
WY
Zip/Postal Code:
*
Email:
*
Phone:
*
(###)
###
####
Name:
First Name
Last Name
Phone:
(###)
###
####
Relationship to you:
Employer (If currently employed):
Please list any special skills you would like to utilize during your volunteering:
*
Describe any prior volunteering and/or group facilitation experience:
*
What motivated you to apply to be a Getting Ahead volunteer?
*
Background check required prior to volunteering.
*
As part of our volunteer screening process, we will complete a background check. Your consent is required to proceed with your application. (A background check form will be provided to you in person to complete and sign).
Liability Release Waiver
*
In consideration of my desire to serve as a Volunteer for St. Vincent de Paul, I hereby assume all responsibility for any and all risk of property damage or bodily injury that I may sustain while participating voluntary work or activity of that nature, including the use of equipment and facilities of St. Vincent de Paul. I currently have no known mental or physical conditions that would impair my ability for full participation as intended or expected of me.
I have read carefully the forgoing release and understand the contents thereof and sign this release on my own free will.
PLEASE ENTER YOUR INITIALS IN THE SPACE BELOW TO CONSENT.
Photo/Media Release Waiver
I give St. Vincent de Paul the right to use my photo in any publication, video, or display, website or broadcast production. It is understood that any and all materials, tape, film or other products connected herewith, and all rights arising from them is the exclusive property of St. Vincent de Paul. I further understand that materials may be shared for other promotional purposes. (This would be verbalized prior to any photos being taken or released.)
PLEASE ENTER YOUR INITIALS IN THE SPACE BELOW TO CONSENT.
Confidentiality
Confidentiality is the legal right to privacy. Any information regarding a client learned through conversations or contained in a client's file is confidential information. No information should be released to anyone without proper authorization. This is a violation of state and federal law. Anyone who discloses information without a current, signed authorization can be held liable for damages or it could be grounds for defamation or invasion of privacy. Both volunteers and St. Vincent de Paul can be liable, but as a volunteer you can also be held liable for civil and criminal penalty. Any volunteer who violates confidentiality will be terminated from their volunteer position at St. Vincent de Paul immediately.
PLEASE ENTER YOUR INITIALS IN THE SPACE BELOW TO CONSENT.
