*Friends Inc. Volunteer Application & COVID-19 Liability Release Waiver

Friends Inc. Volunteer Application/Liability Release Waiver

**Signature Required During Check-in**
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Social Security #
Phone Number*

Area CodePhone Number
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
I would like to volunteer in the following area(s):*

Office AssistantBuffalo Bills Games (Concession Stand)Day Care CenterSenior Social Care ProgramAfter School ProgramBuilding MaintenanceProgram CoordinatorReceptionistMusic TeacherArt TeacherKitchen
I am willing to undergo a background check and fingerprinting:*

YesNo
Emergency Contact*

First NameLast Name
Emergency Contact Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Phone Number*

Area CodePhone Number
Personal Reference*

First NameLast Name
Personal Reference Email*
example@example.com
Personal Reference Phone #*

Area CodePhone Number
Professional Reference*

First NameLast Name
Professional Reference Phone Number*

Area CodePhone Number
Professional Reference Email*
example@example.com
Name of Organization Professional Reference is affiliated with: blanks*
Your job duties, title at this organization and how many years worked: blank*
Due to the outbreak of the novel Coronavirus (COVID-19), Friends Inc. is doing everything we can to protect you, our clients/volunteers, our community and our staff. To this extent, Firends Inc. will be following the Center of Disease-Control (CDC) with regard to social distancing practices and sanitation. We ask that our clients/volunteers disclose their health history and continue to implement these sanitation and disinfection procedures.

Symptoms of COVID-19 include:
- Fever
- Fatigue
- Dry Cough
- Difficulty Breathing
- Loss of taste and/or smell
- Body aches
I agree to the following:*

I, nor members of my household, have not experienced any of the symptoms listed above within the last 14 days.I, nor members of my household, have not travelled internationally in the last 30 days.I, nor members of my household, have not traveled to a highly impacted area within the United States of America is the last 30 days.I, nor members of my household, do not believe that we have been exposed to someone with a suspected and/or confirmed case of the Coronavirus (COVID-19).I, nor members of my household, have not been diagnosed with the Coronavirus (COVID-19) within the last 30 days.Friends Inc. cannot be held liable from any exposure to the Coronavirus (COVID-19) caused by misinformation on this form or the health history provided by each client/volunteer.If I take any steps to make a claim for damages against Friends Inc., its agents, employees or any other released parties, I shall be obligated to pay all attorney’s fees and costs incurred as a result of such claimFriends Inc. agrees to abide by these standards and my signature affirms the same. I hereby certify that all entries on the application are true and complete and I agree and and understand that any falsification of information on this application is subject to verification, and at the time of discovery of any falsification may cause forfeiture on my part of any volunteerism in the service of Friends Inc. I consent to criminal history background check and fingerprinting and I also consent that you may contact my references, former employers and educational institutions listed regarding my application. I further authorize Friends Inc to rely upon and use, as it sees fit, any information received from such contacts.-It is not required, but all clients/volunteers whether vacciniated or unvaccinated are encouraged to wear a surgical mask during the duration of the service/visit or service/entry to the building.Each clients/volunteer is required to sanitize their hands upon arrival and before departureAll materials used will be cleaned, sterilized, and disinfectedAll surfaces will be thoroughly cleaned with hospital grade disinfectant before and after each client/volunteer visit according to the manufacturer’s directions.By signing below, I hereby release and agree to hold Friends Inc. harmless from and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses, and compensation for damages or loss to myself and/or property that may be caused by any act, or failure to act of Friends Inc., or that may otherwise arise in any way in connection with any services received from or volunteer opportunities with Friends Inc. I agree to release Friends Inc. from any and all liability for the unintentional exposure or harm due to the Coronavirus (COVID-19)
Date*

MonthDayYear
Date
Signature*

Clear
Should be Empty:

Friends Inc. Volunteer Application/Liability Release Waiver