VOLUNTEER APPLICATION
Today's Date
First Name
Last Name
Address
Suite/Unit
City
State
Zip Code
Home Phone
Cell Phone
Birth Date
Email
Emergency Contact Name
Phone Number
Skills/Interests/Education:
(Please check the volunteer areas you are interested in volunteering for.)
Release of Liability
I hereby fully and forever waive, release and relinquish and all claims, demands and actions whatsoever that I may have or may accrue to me against SPAN, officers, agents, volunteers and employees arising out of this activity and/or any volunteer activity associated with or connected with this activity. Furthermore, I agree to indemnify and hold harmless and defend SPAN, from any and all claims and actions resulting from injuries, damages and losses sustained by me arising out of, connected with or in any way associated with this volunteer position.I have read this agreement and fully understand its content and sign it of my own free will. I further certify that I am (18) years of age or the parent/legal guardian of a minor participant.
Statement of Confidentiality
As condition of being involved with persons seeking assistance from SPAN , I agree to keep confidentialany information shared with me. I understand that no information concerning clients shall be released to other agencies or persons without signed, written consent of those involved.I recognize that the unauthorized release of confidential information may make me subject to civil action.I further understand that violation of this agreement is grounds for termination of my service.
Printed Name:
Date: