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Volunteer Application
1. Personal Information (The "*" indicates a required value)
Are you at least 18-yrs. old?
Name: *


Home Address: *

City/Town: *

ZIP Code: *

(Street Number/Name, Rural Route, P.O. Box #)
Contact Telephone #: *


Alternate Telephone #: *

E-Mail Address: *

The following information will only be used if a background check is required for the volunteer job you will be performing.
Birthdate: (mm/dd/yyyy) 


 
2. Volunteer Survey
 
   hours of volunteer service for:    


  
   

Please describe why you are required to complete these hours:



Please list any special accommodations that you may need to participate in volunteer opportunities: 

Please list days and times you are available:


 
Do you have your own transportation?
Explain:
3. Interests and Skills
I am interested in volunteering for the following areas (check all that apply):







      
      







      
      
      
      
      
      
      
      
      
      
      
      
      
      
      
      
4. Other Information

Please list any skills or talents that may be useful as a volunteer:
 

Please describe any prior employment or volunteer experiences that may be useful as a volunteer:
 
 
5. Disclosure Statement
Have you ever been convicted of a crime except for minor traffic violations? 
    If yes (Describe), Felony/Misdemeanor below
6. Release of Liability and Confidentiality Agreement
This agreement and release of liability is between the Volunteer and TrueNorth Community Services, its employees, members, agents, and affiliates, hereby referred to as "TrueNorth".

To the best of my knowledge, the information on this sheet is true and accurate. I authorize TrueNorth to disclose pertinent information to other agencies, organizations, churches or individuals for the purpose of sharing volunteer information. I release TrueNorth from any liability for use of images which include myself or family members generated for public relations including but not limited to: printed publications, pictures, videos, television, internet, and electronic media.

I agree to waive and release TrueNorth of any and all liability that could be incurred as a result of my negligence, intentional or unintentional, during my responsibilities as a volunteer for TrueNorth. I further release TrueNorth of all liability with regard to any physical or emotional harm that I may sustain during the time I volunteer at TrueNorth or in any other activity sanctioned by TrueNorth. I agree to indemnify and hold harmless TrueNorth for any costs or liabilities which they may incur as a result of my volunteering at TrueNorth. As a volunteer at TrueNorth, I will receive no financial reimbursement for services rendered.

Through my volunteer work with TrueNorth programs and services, I will have access to information that is considered private. I acknowledge that this information must not be shared with others. In accepting this volunteer role with the agency, I agree to keep all information about program participants, staff, volunteers, and donors confidential. I will not copy, transcribe, record, or memorize confidential information for any reason other than for the limited purpose of providing the assigned services at TrueNorth.

I have had the opportunity to READ and UNDERSTAND this agreement and acknowledge that by signing this document, I am waiving certain legal rights in the event of injury. This agreement shall be governed by and construed in accordance with the laws of the State of Michigan. BY CHECKING THE BOX BELOW, I accept and agree to the terms contained above.
*Do you agree with the Release of Liability and Confidentiality Agreement? 

     
*By selecting 'Yes', you are effectively applying an "electronic signature" to your consent of the above Release of Liability and Confidentiality Agreement

Please note that if you are under 18 years old, a parental consent form is required before volunteering.
"Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has."
- Margaret Mead
 

 

© 2018 TrueNorth Community Services | 6308 S. Warner Ave PO Box 149 | Fremont, MI 49412
Phone: 231-924-0641 | Fax: 231-924-5594 | Form Development by K-Data Systems