Karsh Center Special Projects Volunteers: COVID-19 Community Relief

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 volunteers@karshcenter.org. This application was updated on Wednesday, June 24, 2020.
Name *

First Name Last Name
E-mail *
Birthdate *

Month Day Year
Date
Cell phone number *

Area Code Phone Number
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Emergency Contact Name *

First Name Last Name
Emergency Contact Phone Number *

Area Code Phone Number
Have you volunteered with the Karsh Center before? *

Yes No
Are you a Wilshire Boulevard Temple member? *

Yes No
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. *

Clear
Name (for volunteers under 18 years old, this must be a parent/legal guardian) *

First Name Last Name
Date *

Month Day Year
Date

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) *

Clear
Name of individual signing waiver (for volunteers under 18 years old, this must be a parent/legal guardian) *

First Name Last Name
Date *

Month Day Year
Date
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) *

Clear
Name of individual signing photo and video release form (for anyone under 18 years old, this must be a parent/legal guardian) *

First Name Last Name
Date *

Month Day Year
Date
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Karsh Center Special Volunteer Projects: COVID-19 Community Relief Volunteers

Volunteer Health & Wellness Verification

Volunteer Interest & Capacity

Karsh Center Volunteer Agreement & Waiver

Karsh Center Volunteer Photo Release