Volunteer Sign-Up Form
Coronavirus Quarantine Relief Initiative
Name
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First Name
Last Name
Email
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example@example.com
Phone Number
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-
Area Code
Phone Number
City/Area You Live In
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Your Home Church
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Character Reference: Please list name and phone number of someone from Catalyst or Your Church we can contact about you.
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Volunteer Role You're Signing-Up For
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SERVICE PROVIDER to run errands and/or otherwise provide for the needs of vulnerable people. (Must have no Coronavirus symptoms/have had no contact with anyone who has, be between 16-60 years old, provide own transportation/gas)
Have you ever committed, or been charged with, a felony or any other crime involving neglect, abuse, or sexual assault of any child or adult?
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Yes
No
RELEASE OF LIABILITY WAIVER - Volunteer understands that Catalyst does not carry health, medical, or disability insurance coverage for any Volunteer; and that, in the event that I/my child am/is injured in any way, any personal medical and hospitalization insurance available to me/my family will provide sole coverage. I also understand that Catalyst does not assume any responsibility for or obligation to provide financial assistance or other assistance, including but not limited to medical, health, or disability insurance in the event of injury or illness. I understand and acknowledge that my involvement in this endeavor with Catalyst, its agents and contractors, and any partnering organizations, hereafter referred to as ‘Catalyst,’ is voluntary. I give Catalyst, and any other partnering organization, permission to verify my information, and perform personal & criminal background checks. I understand that the background check process, or any false or misleading information I have given, may disqualify me from involvement. I also voluntarily submit myself to the supervision of Catalyst staff, officers, agents, employees, volunteers, etc., for all activities which are part of this project. I hereby acknowledge and understand that I am responsible for providing my own transportation to/from Catalyst events/activities. Catalyst is in no way responsible for, nor does Catalyst assume liability for, any injury or loss resulting from my transportation.
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Agreed
Not Agreed
The Information I Have Provided on This Form is True and Accurate
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Type your name here to verify
Thank you for being the Church!
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