Volunteer Application

  • Volunteer Application

  • Emergency Contact:    *   *      * 
    Relationship   *    

  • This question is optional. It is used for demographic purposes.

  • Confidentiality Agreement

    I understand that, serving as an employee/volunteer of UAF Legacy Health, I may have access to confidential information concerning UAF Legacy Health, its staff members and its clients.  This information may be generated within UAF Legacy Health or obtained from outside sources.  Improper disclosure of confidential information constitutes a violation of trust and can involve UAF Legacy Health in serious litigation. Access may also be provided to information handling technology, such as computer systems and programs, which UAF Legacy Health has exclusive right to use and/or may be contractually bound to use in prescribed ways.  I acknowledge that misuse of information handling technology can constitute a violation of contractual and perhaps a violation of the law as well.  Consequently, I agree as a contractual condition of my participation in UAF Legacy Health that I will treat confidential information confidentially and use information handling technology carefully and not for personal gain or in violation of other privacy restrictions or requirements.  I further agree not to remove confidential documents, including lists, tapes and computer programs from UAF Legacy Health's premises without prior written authorization from UAF Legacy Health Chief Executive Officer.  I understand that any violation of this on my part will be considered grounds for immediate termination and UAF Legacy Health may pursue appropriate recourse to carry out the terms of this agreement.
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  • Procedure Agreement

    In consideration of the training which I have/will receive from UAF Legacy Health and the trust and confidence which has been placed with me, I agree to the following: I agree to hold harmless and waive any liability against the UAF Legacy Health for any accident, injury, loss, damage, etc., that I may incur or suffer while acting as a volunteer of the UAF Legacy Health, and I agree to assume all risk associated with my volunteer duties, I have obtained the minimum insurance as required by the State of Utah and I accept responsibilities associated herewith.
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  • Photographic Release

  • I,     , hereby give permission to UAF Legacy Health, its representatives and employees the right to take photographic images of me, film/video footage of me, or sound recordings of my voice. I authorize the UAF Legacy Health, its assigns and transferees to copyright, use, and publish the same in print and/or electronically.

    I understand that I will not receive remuneration of any kind.

    Moreover, I hereby waive claim to any rights, residuals, fees or other charges in connection with photographs, film/video footage or sound recordings with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content. 

    UAF Legacy Health greatly appreciates your participation.

        
                   

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