VOLUNTEER APPLICATION

The KC Shepherd's Center provides programs, leadership and advocacy to help both active and homebound older adults live healthy, engaged and independent lives.

Criminal Background and DMV Check Release

I hereby certify that the facts set forth during the volunteer application process are true and complete to the best of my knowledge. I understand that if during volunteering application, I falsified statements during the application process may result in dismissal. I release and hold harmless any person, firm or entity that discloses matters in accordance with this authorization, as well as from liability that might otherwise result from the request for use of and/or disclosure of any or all of the foregoing information.

I hereby authorize KC Shepherd’s Center to perform a background check as a condition of my being a volunteer.

Conflict of Interest Policy

Members of the Board of Directors, staff and volunteers of KC Shepherd’s Center are restricted from any activity, situation or circumstance from which they will personally profit. Such conflicts would exist when an individual directly or indirectly, or one of his family:

1.Owns any beneficial interest or serves as a director, officer, employee, consultant or agent in an organization which has current or prospective business transactions with KCSC.

2.Seeks or accepts any gifts or favor from any person or organization which has current or prospective business with KCSC, if the acceptance or prospect of future gifts or favors may tend to limit or restrict an individual from acting with absolute impartiality with respect to such organization in current or future business transactions.

3.Uses for personal gain or to benefit others, the property, records, services, name, emblem or endorsement of KCSC.

4.Sells or offers for sale for personal gain any information gained through affiliation with the KCSC.

 

Publicity Release Form

In return for being allowed to participate in Shepherd’s Center Central volunteer activities and all related activities, including any activities related to participation (“Volunteer Activities”), the undersigned Volunteer or Parent/Legal Guardian of Volunteer hereby grants to KC Shepherd’s Center rights and permission to use, publish, broadcast and/or copyright the use of Volunteer’s name, voice, photograph and/or likeness, caricature, and information, in its current form or as retouched, digitized, cropped, altered, or modified in any way, in any and all advertising, promotional, or other materials based upon or derived from the Volunteer Activities in any manner, in any media whatsoever for any and all purposes, including but not limited to:
•advertising
•promoting or publicizing services
•social media and websites
•newsletters
•recruitment pieces
Volunteer understands these will be published without additional compensation.
Volunteer understands that this document is intended to be as broad and inclusive as permitted by the laws of the state in which the Volunteer Activities take place.

Volunteer Confidentiality Agreement

• I acknowledge and confirm that as a volunteer I may acquire information on the organization, its clients, staff and volunteers, and about certain matters and things which are of a confidential nature and that such information is the exclusive property of the organization and will remain in the strictest confidence.
• 
  I affirm that the information referred to above could be used to the detriment of the organization and the volunteer activities and thereby undertake to treat as confidential all information, contracts or resources. I agree not to disclose the same to any third party either during the term I am volunteering for the organization or at any time thereafter unless required by law to do so.
• 
  I agree that any knowledge gained as a result of my position will remain in strictest confidence.
• 
  I acknowledge that any client contributions are confidential. I agree that I will give all monies to the KCSC Program Manager or Executive Director without disclosing the name of the client who contributed. Furthermore, to assist SCKC, I will indicate on the volunteer sign-in sheet that a contribution in said amount was given to either person.
• 
  I agree to exercise due care to ensure that any information I may give to others in the course of my duties as a volunteer or otherwise is information that has been pre-approved by MARC and KC Shepherd’s Center.
  I agree I will not discuss the details of my volunteer work with any representatives of the media or publicize any of the confidential aspects of my work orally or by written work or any other medium of communication.
• I confirm that I have read the above statements and agree with them and I will therefore adhere to all confidential requirements contained in this agreement or as may be otherwise directed to me in writing by my supervisor as a volunteer.