HeartStrings Volunteer Application HeartStrings Volunteer Application Home /Get Involved/HeartStrings Volunteer Application HeartStrings Volunteer Application Name(Required) First Last Today's Date(Required) MM slash DD slash YYYY Email(Required) Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone(Required)Date of Birth(Required) MM slash DD slash YYYY Gender(Required) Male Female Availability(Required) Sunday Monday Tuesday Wednesday Thursday Friday Saturday Select AllHours Available to VolunteerPlease indicate on the dates selected above what hours you are available to volunteer.How often are you able to volunteer?(Required) Weekly Monthly Periodically Specific Date and Times Select AllIf you checked specific dates and times, please list them below.Interests & SkillsAreas of Interest (check all that apply): Heartstrings Program: Art Heartstrings Program: Music Heartstrings Program: Arts & Crafts Heartstrings Program: Yoga Holiday Projects & Events Staff Appreciation Select AllSkills (check all that apply): Drawing Painting Graphic Design Videography Photography Music Dance Theatre Other (please explain below) Select AllIf you checked "other" above, please explain.If you are proficient in a language other than English, please list below. Previous Volunteer ExperienceReferences (list up to 3)ReferencesPlease provide up to three of your reference’s name, relationship, and contact number. Add RemoveEmergency ContactPlease provide the name, home phone, and cell phone number for the person to contact in case of an emergency.Application Agreement StatementFor the safety and security of the children, families and staff of Children’s Hope Alliance, I understand and agree that my references will be checked, and prior to volunteering I will be subject to a criminal background check and other appropriate screenings. By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a volunteer, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal.Application Agreement(Required) I have read, understood and agree to these terms.Confidentiality AgreementI understand that Children’s Hope Alliance protects youth and staff by keeping all information completely confidential and secure. I also understand and agree that it is my responsibility to support the established measures that safeguard such confidential information. At no time will I disclose any youth or staff information without prior approved authorization. I understand that violation of this confidentiality agreement may result in civil penalties and may result in my immediate dismissal.Confidentiality Agreement(Required) I have read, understood and agree to these terms.Media Release Agreement StatementI give my permission to allow my name and/or photographs to be used by Children’s Hope Alliance for agency newsletters, public relations and fundraising purposes now or in the future.Media Release Agreement Statement(Required) I have read, understood and agree to these terms.Disclaimer for Volunteers StatementI have no criminal convictions that would adversely affect my capacity and ability to provide care, safety and security for the children in residence. I have not abused or neglected a child. I have not had child protective services involvement that resulted in the removal of a child. I have not been a respondent in a juvenile court proceeding that resulted in the removal of a child. I have not abused, neglected or exploited a disabled adult. I have not been a domestic violence perpetrator.Agreement to the Disclaimer for Volunteers(Required) I certify that the above statements are true and understand that my employment, or my relationship with the agency as a Volunteer, may be terminated for making a false statement.Discrimination StatementI give my permission to allow my name and/or photographs to be used by Children’s Hope Alliance for agency newsletters, public relations and fundraising purposes now or in the future.CAPTCHA Questions? Call or email to request more information about the list above, send an email to email@example.com.