Karsh Center Special Volunteer Projects: COVID-19 Community Relief Volunteers
Thank you very much for your interest in supporting the Karsh Center's efforts to feed and care for our neighbors during this time. To best keep our very vulnerable client population as well as our volunteers safe, each individual interested in volunteering must fill out the form below. Our volunteer activities at this time are limited, so as to keep contact among individuals as low as possible. If you would like to help as a family unit, couple, or with a friend, this form must still be completed for each individual. This application has four sections: 1) basic profile and contact information, 2) health and wellness verification, 3) volunteer interests and capacity, 4) Karsh Center volunteer agreement and waiver. After you submit this form, our team will be in touch about next steps as volunteers are needed. Thank you for your patience, and desire to serve our neighbors during this time of great need. If you have any questions, please reach out to firstname.lastname@example.org. This application was updated on Wednesday, June 24, 2020.
Cell phone number
Street Address Line 2
State / Province
Postal / Zip Code
Antigua and Barbuda
Bosnia and Herzegovina
Central African Republic
Cocos (Keeling) Islands
Democratic Republic of the Congo
Turkish Republic of Northern Cyprus
Papua New Guinea
Republic of the Congo
Saint Kitts and Nevis
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Sao Tome and Principe
Trinidad and Tobago
Tristan da Cunha
Turks and Caicos Islands
United Arab Emirates
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Emergency Contact Name
Emergency Contact Phone Number
Have you volunteered with the Karsh Center before?
Are you a Wilshire Boulevard Temple member?
How did you learn about the Karsh Center?
Volunteer Health & Wellness Verification
These policies have been prepared in accordance with county, state, and federal guidelines and in consideration of the unique needs of Karsh Center clients, volunteers, and staff. They were last updated and reviewed on June 18, 2020 and are subject to change. For volunteers younger than 18 years old, parent or legal guardian must e-sign on their behalf.
I have read this Karsh Family Social Service Center COVID-19 Visitor Protocol, and I understand that I am responsible for following these protocols as a condition to my entrance into the Karsh Center. I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that I may be exposed to or infected by COVID-19 by visiting the Karsh Center and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I release, hold the Karsh Center harmless against, and give up any and all claims, causes of action, loss or damages (“Released Claims”) I now or in the future have against the Karsh Center and Wilshire Boulevard Temple, and each of their respective successors, officers, directors, members, shareholders, employees, agents, representatives, insurers and assigns (the “ReleasedParties”) arising from or relating to COVID-19, including, but not limited to, any and all claims, causes of action, loss or damages I now or in the future have for bodily injury, emotional or psychological injury, property damage, loss or death due to the active or passive negligence of any of the Released Parties, and specifically including (but not limited to) (i) exposure or potential exposure to COVID-19, (ii) the negligent acts or omissions of the Karsh Center and/or the Released Parties related to or arising out of COVID-19 or efforts to protect against COVID-19, (iii) illness, physical injury, bodily injury, or death arising out of COVID-19, and (iv) exposure to any individuals at the Karsh Center who have the virus, or to property that may hold or contain COVID-19. Digital Signature below. For anyone under 18 years old, this should be a parent or legal guardian.
Name (for volunteers under 18 years old, this must be a parent/legal guardian)
Volunteer Interest & Capacity
The Karsh Center is working to stay flexible in an effort to best respond to client and community need. Below are some possible volunteer activities that either are currently happening or may be launched in the near-future. On-site volunteer activities will take place with a limited number of volunteers in one space, per the most recent CDC recommendations. All on-site volunteers will be required to adhere to the most recent Karsh Center safety procedures (per the previous page of this application). Additionally, the Karsh Center facility will undergo cleaning regularly throughout the day.
Which of the following activities are of interest to you? (Select all that apply) The Karsh Center urges individuals considered by the CDC to be "at higher risk for severe illness" to act with caution and consider only applying for remote volunteer activities. Visit this site for more information: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-at-higher-risk.html
Remote volunteering - something I can do from my home
On-site volunteering - in isolation (ex: preparing supplies in a space without others)
On-site volunteering - client services (ex: assisting with handing off supplies to clients who come to receive essentials, maintaining proper social distance and CDC guidelines around number of people in one space)
Driving: pick-ups and deliveries of food and essential items
Outreach and communication
Donate essential supplies
Translation of materials into other languages
Do you speak any of the following languages fluently?
Please select which of the following are true for you:
I have access to a phone, and am interested in doing phone outreach to Karsh Center clients and community organizations.
I have a computer, and am interested in doing virtual outreach to Karsh Center clients and community organizations.
I have a car and/or will drive the Karsh Van, and am interested in assisting with distributing and/or dropping off essential items (such as groceries, diapers, or hygiene items) to Karsh Center clients and/or community organizations
I would like to organize a drive/assemble bulk items for hygiene kits (new socks, toothbrushes, toothpaste, soap, shampoo/conditioner, lotion, deodorant, razors, shaving cream, hand sanitizer, wipes, tissues)
I am interested in volunteering at the Karsh Center, and/or any other Karsh Center Collaborators or community organizations that may be in need of volunteer support at this time
If you are interested in doing a volunteer role that includes driving/pick-ups, what size/model of vehicle do you have?
Are there any other ideas you have or ways you would like to contribute as a volunteer?
Karsh Center Volunteer Agreement & Waiver
Please review the Karsh Center's waiver, linked below and required of all individuals who volunteer with Karsh Center programs and services. E-signature must be provided by the individual volunteer. For volunteers younger than 18 years old, parent or legal guardian must e-sign on their behalf.
Volunteer Agreement & Waiver Signature (use mouse/cursor to write out signature)
Name of individual signing waiver (for volunteers under 18 years old, this must be a parent/legal guardian)
Karsh Center Volunteer Photo Release
Please review the Karsh Center's photo release, linked below. E-signature should be completed by the individual applicant, except for volunteers younger than 18 years old, for whom parent or legal guardian must e-sign on their behalf.
Photograph & Video Release Signature (use mouse/cursor to write out signature)
Name of individual signing photo and video release form (for anyone under 18 years old, this must be a parent/legal guardian)
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