Volunteer Information and Release Form

In consideration of my desire to serve as a volunteer for Pivot, Inc. I hereby assume all responsibility for any and all risk of property damage or bodily injury that I may sustain while participating in any activity related to my service at Pivot.

I understand that some volunteer positions will require the completion of a criminal background check and/or drug screening. 

I understand that I am not to take photos of clients and that the safety, well-being, and confidentiality of the youth served are priority to Pivot. 

I currently have no known mental or physical condition that would impair my capability for full participation as intended or expected of me. 

I understand that Pivot is under 24-hour surveillance and that possession and use of alcohol, tobacco, illegal substances, firearms, and weapons are prohibited on Pivot's campus and at any events. 

If I find myself in an unsupervised situation with a minor, I will ask the minor where their youth advocate is, and/or direct them to the receptionist. 

Unless noted above, I also give consent to have my photo taken, be interviewed, and/or filmed for marketing purposes to promote the mission of Pivot. I further grant permission to Pivot to use, without compensation or approval any photographs, videos, or audio recordings taken of me while volunteering or participating in Pivot activities.

By my signature below, I do release and indemnify, and hold harmless Pivot from and against any claims, actions, suits, or proceedings of any kind or nature arising as a result of the actions of myself or my child. I also release the officers, staff and Board of Trustees of Pivot, without limitation for damages, liabilities, penalties, costs, expenses, legal fees, claims. 

I acknowledge that I have carefully read and understand this release and am voluntarily executing this release.

 

 

Every effort needs to be made to protect all client privacy.

 

The following guidelines are to be observed in an effort to protect the confidentiality/privacy of all people either applying for or receiving services from Pivot, Inc: 

1. Communications regarding clients or client activities are not permitted outside Pivot.
2. Clients and/or client-related issues are not to be discussed in any public areas or where others are present to overhear the conversation.
3. No photos, videos, or any recording of clients are allowed unless a signed release is on file for that client and you receive express permission from your supervisor, the Chief Executive Officer, or the Pivot staff member you are visiting.
4. Do not leave anything (letters, notes, files, etc.) which contains client names or information where it could be read by anyone. At the end of a working/volunteer shift or day, all information containing a client's name should be locked up. 
5. if you see/encounter a client away from Pivot, Inc., wait for the client to initiate contact/speak first. This method of protecting the client's privacy is to be explained to clients at the time of intake (initial session).

All guidelines regarding the release of information from the client record are discussed in Pivot's Policies and Procedures Manual. In addition, the Policies and Procedures Manual discusses confidentiality/privacy and the necessity of refraining from having social interactions with clients and their families. 

Any additional questions about confidentiality or privacy are to be referred to your supervisor, the Chief Executive Officer, or to the Pivot staff member you are visiting. 

A breach of confidentiality is grounds for dismissal from employment or volunteer status at Pivot, Inc. 

If a breach of confidentiality occurs by a non-staff member which results in legal action against him/herslef, he/she will indemnify and hold harmless Pivot. Inc. 

 

I agree to abide by  Pivot, Inc.'s confidentiality/privacy policies and to protect, at all times, a client's right to privacy.