VOLUNTEER REGISTRATION FORM

Transcription

1 VOLUNTEER REGISTRATION FORM Office Use Only Prgram: Site: Day(s): Time: Name Phne Number (cell) (hme) (Wrk) Address Birth date What is yur current ccupatin? Are yu r have yu ever been a member f the military? Are yu a student? If s, where/what year? Hw did yu find ut abut us? (Please be specific) Why are yu interested in vlunteering with Aspire!? Have yu vlunteered previusly? If s, where/when? Have yu wrked with children and/r yuth befre? If s, where/when? Please list any special interests, talents, r hbbies yu have that may benefit the children & families at Aspire!. (i.e. arts & crafts, drama, cmputer, science, sprts, etc.) May we add yu t Aspire! s Ggle grup / listserve? (This list will be used t share imprtant infrmatin including prgram updates, schedule changes, and mre with active vlunteers. It is als a frum fr active vlunteers t interact with each ther.) Yes N May we add yu t ur mailing list s yu can receive ur newsletter? Yes N Please list ne adult (nn-relative) reference Name: Phne: Relatinship t yu:

2 VOLUNTEER AGREEMENT *I agree t cmmit t vlunteering at Aspire! Afterschl Learning n the fllwing day(s) f the week: Hurs: Mnday: Tuesday: Wednesday: Thursday: Friday: Start date End date Prgram: Learning ROCKS! Afterschl Summer Camp Site: Arlingtn Mill Virginia Gardens Buchanan Gardens As a vlunteer with Aspire! Afterschl Learning: I agree t have Aspire! Afterschl Learning perfrm a criminal backgrund check n me and pay the fee f $20.00** t d s. (Nt applicable if vlunteer is under 18 years f age.) I have read Aspire! Afterschl Learning s Vlunteer Guidelines, Rles, & Respnsibilities and agree t adhere t them. I recgnize the right f Aspire! Afterschl Learning t terminate the services f any vlunteer at any time if they deem the vlunteer/prgram relatinship is nt successful. I agree t give the Vlunteer Crdinatr and/r my site supervisr as much advance ntice as sn as pssible if I cannt keep my vlunteer time. Vlunteer s Name Signature Signature f Parent/Guardian (if under 18 years ld) Staff Signature

3 VOLUNTEER RELEASE FORM VOLUNTEER ACTIVITY RELEASE As a part f being given clearance t wrk as a vlunteer fr Aspire! Afterschl Learning, I,, accept sle respnsibility fr any injury that I may incur during the time in which I am wrking as a vlunteer fr Aspire! Afterschl Learning. I further hereby release Aspire! Afterschl Learning and its emplyees and agents frm any and all claims r cause f actin arising frm any accident r injury I may suffer during the time in which I am vlunteering, except fr any claims r causes f actin which arise frm an accident r injury which is due t the negligence f Aspire Afterschl Learning. Vlunteer Name Vlunteer Signature Parent/Guardian Signature (if vlunteer is under 18 years ld) VOLUNTEER PRIVACY POLICY Aspire! Afterschl Learning respects the privacy f all vlunteers and staff. We cllect persnal cntact infrmatin, demgraphics and vlunteer interests. We als cnduct criminal backgrund checks n vlunteers wh are 18 r lder, which cntain persnal identificatin infrmatin. We WILL NOT prvide yur persnal identifying infrmatin (e.g., name, cntact infrmatin r vlunteer infrmatin), r the results f yur backgrund check t third parties unless yu indicate therwise. We cllect this infrmatin fr internal use nly. By signing belw, I acknwledge that I have read and understd Aspire! Afterschl Learning s Vlunteer Privacy Plicy. Vlunteer Name Vlunteer Signature Parent/Guardian Signature (if vlunteer is under 18 years ld) PHOTO RELEASE I give Aspire! permissin fr any respnsible use f phtgraphs taken at Aspire! spnsred events in which I appear. I understand that the phtgraphs may be used in displays, publicatins, r sent t the press fr publicatin in a newspaper r use n televisin. Vlunteer Name Vlunteer Signature Parent/Guardian Signature (if vlunteer is under 18 years ld)

4 BACKGROUND INVESTIGATION CONSENT I, *, hereby authrize Aspire! Afterschl Learning, and/r its agents t make an independent investigatin f my backgrund, references, character, past emplyment, educatin, credit histry, criminal r plice recrds, including thse maintained by bth public and private rganizatins and all public recrds fr the purpse f cnfirming the infrmatin cntained n my Applicatin and/r btaining ther infrmatin which may be material t my qualificatins fr emplyment nw and, if applicable, during the tenure f my emplyment/vlunteering with Aspire! Afterschl Learning. I release Aspire! Afterschl Learning and/r its agents and any persn r entity, which prvides infrmatin pursuant t this authrizatin, frm any and all liabilities, claims r law suits in regards t the infrmatin btained frm any and all f the abve referenced surces used. The fllwing is my true and cmplete legal name and all infrmatin cntained herein is true and crrect t the best f my knwledge: * * Applicant/Emplyee Name and Signature * - - * Scial Security Number * f Birth *NOTE: The abve infrmatin is required fr identificatin purpses nly, and is in n manner used as qualificatins fr emplyment. Aspire! Afterschl Learning is an Equal Opprtunity Emplyer, and des nt discriminate n the basis f Sex, Race, Religin, Age (40 and ver), Handicap r Natinal Origin. *Printed Name *Street Address *City, State, Zip CA, MN & Oklahma Residents please nte: In cnnectin with yur applicatin fr emplyment, yur credit reprt will be btained and reviewed. Under CA & MN law, yu have a right t receive a free cpy f yur credit reprt by checking the apprpriate bx belw. Yur credit reprt will be mailed t yu by the credit bureau. Under Oklahma law, yu have the right t receive a free cpy f yur cnsumer reprt. YES, I am a Califrnia resident and wuld like a free cpy f my credit reprt; r YES, I am a Califrnia resident and wuld like a free cpy f my investigative cnsumer reprt YES, I am a Minnesta resident and wuld like a free cpy f my cnsumer reprt. YES, I am an Oklahma resident and wuld like a free cpy f my cnsumer reprt. Emplyer please nte: If the cnsumer checks Yes regarding the cnsumer reprt, r if a CA cnsumer checks Yes regarding the credit reprt (and yu d request a credit reprt, please fax this frm t yur ChicePint service center. If cnsumer checks Yes regarding the full cnsumer reprt, and cnsumer resides in CA, yu will need t prvide the individual with a cpy f their cnsumer reprt. Accunt Number:

5 VOLUNTEER REFERENCE RELEASE I acknwledge that I have been infrmed that it is Aspire! Afterschl Learning s general plicy t disclse in respnse t a prspective emplyer's request nly the fllwing infrmatin abut current r frmer emplyees: (1) the dates f emplyment, (2) descriptins f the jbs perfrmed, and (3) salary r wage rates. By signing this release, I am vluntarily requesting that Aspire! Afterschl Learning depart frm this general plicy in respnding t reference requests frm any prspective emplyer that may be cnsidering me fr emplyment. I authrize Aspire! Afterschl Learning t disclse t such prspective emplyers any emplyment-related infrmatin that Aspire Afterschl Learning, in its sle discretin and judgment, may determine is apprpriate t disclse, including any persnal cmments, evaluatins, r assessments that Aspire! Afterschl Learning may have abut my perfrmance r behavir as an emplyee. In exchange fr Aspire! Afterschl Learning s agreement t depart frm its general plicy and t disclse additinal emplyment-related infrmatin pursuant t my request, I agree t release and discharge Aspire! Afterschl Learning and Aspire! Afterschl Learning s successrs, emplyees, fficers, and directrs fr all claims, liabilities, and causes f actin, knw r unknwn, fixed r cntingent, that arise frm r that are in any manner cnnected t Aspire! Afterschl Learning s disclsure f emplyment-related infrmatin t prspective emplyers. This release includes, but is nt limited t, claims f defamatin, libel, slander, negligence, r interference with cntract r prfessin. I acknwledge that I have carefully read and fully understand the prvisins f this release. I further acknwledge that I was given the pprtunity t cnsult with an attrney r any ther individual f my chsing befre signing this release and that I have decided t sign this release vluntarily and withut cercin r duress by any persn. This release sets frth the entire agreement between Aspire! Afterschl Learning and me, and I acknwledge that I have nt relied upn any representatin r statement, written r ral, nt set frth in this dcument. Print Name Vlunteer Signature Parent/ Guardian Signature (if vlunteer is under the age f 18) Executive Directr Signature