*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):

Other
I am willing to undergo a background check and fingerprinting:
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:

Friends 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.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
Should be Empty:

Friends Inc. Volunteer Application/Liability Release Waiver