Volunteer Application - Children's Hope Alliance

Name(Required)

First Last

Today's Date(Required)

Email(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Date of Birth(Required)

Gender(Required)

Male

Female

How often are you able to volunteer?(Required)

Weekly

Monthly

Periodically

Specific Date and Times

Interests & Skills

Interests (check all that apply):

Landscaping

Supply Drives

Music & Art

Secretarial Work

Seasonal Events

General Volunteer Opportunities

Other (please explain below)

If you checked "other" above, please explain.

Please describe your desired volunteer opportunity.

References (list up to 3)

References

Please provide up to three of your reference’s name, relationship, and contact number.

Emergency Contact – Required*

Please provide the name, home phone, and cell phone number for the person to contact in case of an emergency.

Application Agreement Statement

For 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.

Confidentiality Agreement

I 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.

Media Release Agreement Statement

I 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.

Disclaimer for Volunteers Statement

I 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.

Discrimination Statement

I 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.

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