PNO VOLUNTEER Registration

Volunteer Sign-up: Parents' Night Out -

a Program of ASA Now
We feel privileged to serve children and youth ages newborn through 17 at Jacob's Mission Community Center. Our community center is located in East Mesa at 7830 E. University Drive, between Sossaman and the 202 Red Mountain Freeway.

Many children coming through the foster care system have special physical, mental health and developmental needs. Many of these children have suffered varying degrees of trauma, neglect and abuse which often manifests as challenging and extreme behaviors requiring above-average attention.

Caring for children impacted by foster care on a daily basis can be very stressful and difficult for foster and foster adoptive parents. This ultimately takes a toll on the family as a whole. ASA Now provides a much needed break for exhausted foster and adoptive parents while still meeting the special needs of the children. This intervention provides parents with an opportunity to recharge, prevent burn-out, stabilize the whole family, and ultimately result in fewer foster and adoptive disruptions.

ASA Now is in need of caring volunteers to help with our next Parent's Night. You may volunteer to supervise children, run an activity or serve food.

Volunteers supervising children will be assigned one child or two youth and will be playing games, doing crafts, and serving pizza and fruit to the children.

BACKGROUND CHECKS ARE REQUIRED FOR ALL ADULT VOLUNTEERS AGES 18 AND UP WHO WILL BE VOLUNTEERING AT THIS EVENT. WE CAN ASSIST WITH HELPING YOU OBTAIN ONE. Youth (ages 12-17) are not required to have a background. Information to obtain a background check can be found HERE.

This event includes dinner and childcare for ALL of the children and/or youth in attendance. Dinner will also be included for all of our amazing volunteers!

Event is from 4pm to 7pm pm but sign-in times for childcare is staggered and starts at 3:45 am. We ask that all volunteers arrive no later than 3:30 pm to receive instructions before the children start arriving.

Mature teens who wish volunteer or who would like to receive volunteer credit hours are welcome to attend. If you are in need of community service hours, please contact us at 623-428-1592.

Childcare volunteers will be matched with a child based on age preference for this event. Please note that your sign up might be moved to the age bracket where you are needed. Unfortunately, there are always last minute changes as some foster children leave the families homes and others come in. Thank you for your willingness to serve!

To read a list of all of our volunteer activity opportunities click HERE.

If you register to volunteer and then cannot attend, we ask that you call us with as much advance notice as possible at 623-428-1592. We need to ensure that we have enough volunteers for the families who register.

HEALTH AND WELLNESS

This has been a year of adapting, and as you know, we have had to make changes so that we can keep attendees and volunteers safe and comply with local guidelines. If any member of your household has had any symptoms that could potentially be COVID-19 symptoms within the 7 days of the event OR been exposed to someone with COVID-19 or have been tested and are awaiting results, please refrain from attending the event. Masks encouraged but not required.

Volunteers with symptoms of any contagious illness such as a cough, shortness of breath or difficulty breathing, muscle aches, headache, chills, runny nose, or fever should stay home. Please notify us as soon as possible if you are unable to attend.

* ASA Now is a volunteer driven Arizona Qualifying Foster Care Charitable Organization founded by three foster/adoptive moms from Gilbert. Arizona tax law allows those who donate to a qualifying Foster Care charitable organization to receive a maximum tax credit of $1,000 for joint filers and $500 for single filers. This donation is more than just a deduction. It is a dollar for dollar reduction in what you owe or an increase in your refund.

EIN #81-2819648 QFCO #10046
https://azdor.gov/sites/default/files/CREDITS_2021_qfco.pdf

Jacob’s Mission Community Center

7830 E. University Dr.
Mesa AZ 85207
623-428-1592

HELPING CHILDREN IN FOSTER CARE
VOLUNTEER - DONATE - SHARE

Thank you for your willingness to serve!

With Gratitude,

Anika Robinson
President

Please take a moment to fill this form out in it's entirety.

*Be sure to CONSENT, SIGN & hit the SUBMIT button*
Registering Volunteer*

First NameLast Name
Email*
example@example.com
Primary Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Birthday*

MonthDayYear
Date
Gender*
Volunteer Date (Select All that Apply):

Saturday November 16th, 2024
Are you over the age of 18?

YesNo
BACKGROUND CHECK:

Parents place an immense amount of trust in the person or people responsible for caring for their children. It is for that reason that we ask that all participating adults (age 18 and older) have a background check. We can assist you in obtaining a background check. Your cost is $12 and it is valid for two years. Please follow directions below to obtain a background check. If you already have a background check please attach it to this form or email us the copy. If you volunteered at a past event and already received your background clearance you do not need to get clearance again. We have it on record that you have been verified. **If you are volunteering and already have a fingerprint clearance card, please upload it to this form.***If you need to have your background checked, your cost is $12, please log on to Averity at:https://opportunities.averity.com/ASANowPlease note that you will need to provide your full name, social security, date of birth and email. You'll need a credit card to pay on-line. You may skip all other questions such as previous address by simply typing a few letters. You will receive a follow up email from Averity with your background information. On behalf of the foster parents, thank you so much for your support!
Do you have a current Level 1 Fingerprint Clearance Card & Background Check?*

Yes, I will upload belowYes, I am a previous volunteer and ASA Now has a copy on fileNo, I will obtain a background check through link provided aboveNo, I am a teen (under 18)
If yes, please upload documentation here:*

Browse Files
attach clearance card Cancelof
Are volunteers attending part of a business, school or church event?*

YesNo
Name of Business, School or Church/Ward (if applicable):*
Total Number of Volunteers registering on this sign-up? (One per household)*

Emergency Contact During Event
Emergency Contact*

First NameLast Name
Emergency Contact Phone Number*

Area CodePhone Number
Emergency Contact Relation*
Ex: Spouse, Parent, Grandparent, etc.

Volunteer Team Interest
Description of Service Opportunities

We offer many different opportunities to serve. Please select to volunteer for Childcare OR an Activity. Only select one category. Select NONE if you are not volunteering under that category.
Do you have additional volunteers to register?*

YesNo

Volunteer Name #2*

First NameLast Name
Birthday*

MonthDayYear
Date
Gender*
Are you over the age of 18?

YesNo
BACKGROUND CHECK:

Parents place an immense amount of trust in the person or people responsible for caring for their children. It is for that reason that we ask that all participating adults (age 18 and older) have a background check. We can assist you in obtaining a background check. Your cost is $12 and it is valid for two years. Please follow directions below to obtain a background check. If you already have a background check please attach it to this form or email us the copy. If you volunteered at a past event and already received your background clearance you do not need to get clearance again. We have it on record that you have been verified. **If you are volunteering and already have a fingerprint clearance card, please upload it to this form.***If you need to have your background checked, your cost is $12, please log on to Averity at:https://opportunities.averity.com/ASANowPlease note that you will need to provide your full name, social security, date of birth and email. You'll need a credit card to pay on-line. You may skip all other questions such as previous address by simply typing a few letters. You will receive a follow up email from Averity with your background information.On behalf of the foster parents, thank you so much for your support!
Do you have a current Level 1 Fingerprint Clearance Card & Background Check?*

Yes, I will upload belowNo, I am a previous volunteer and ASA Now has a copy of fileNo, I will obtain a background check through link provided aboveNo, I am a teen (under 18)
If yes, please upload documentation here:*

Browse Files
attach clearance card Cancelof
Do you have additional volunteers to register?*

YesNo

Volunteer Name #3*

First NameLast Name
Birthday*

MonthDayYear
Date
Gender*
Are you over the age of 18?

YesNo
BACKGROUND CHECK:

Parents place an immense amount of trust in the person or people responsible for caring for their children. It is for that reason that we ask that all participating adults (age 18 and older) have a background check. We can assist you in obtaining a background check. Your cost is $12 and it is valid for two years. Please follow directions below to obtain a background check. If you already have a background check please attach it to this form or email us the copy. If you volunteered at a past event and already received your background clearance you do not need to get clearance again. We have it on record that you have been verified. **If you are volunteering and already have a fingerprint clearance card, please upload it to this form.***If you need to have your background checked, your cost is $12, please log on to Averity at:https://opportunities.averity.com/ASANowPlease note that you will need to provide your full name, social security, date of birth and email. You'll need a credit card to pay on-line. You may skip all other questions such as previous address by simply typing a few letters. You will receive a follow up email from Averity with your background information.On behalf of the foster parents, thank you so much for your support!
Do you have a current Level 1 Fingerprint Clearance Card & Background Check?*

Yes, I will upload belowYes, I am a previous volunteer and ASA Now has a copy on fileNo, I will obtain a background check through link provided aboveNo, I am a teen (under 18)
If yes, please upload documentation here:*

Browse Files
attach clearance card Cancelof
Do you have additional volunteers to register?*

YesNo

Volunteer Name #4

First NameLast Name
Birthday*

MonthDayYear
Date
Gender*
Are you over the age of 18?

YesNo
BACKGROUND CHECK:

Parents place an immense amount of trust in the person or people responsible for caring for their children. It is for that reason that we ask that all participating adults (age 18 and older) have a background check. We can assist you in obtaining a background check. Your cost is $12 and it is valid for two years. Please follow directions below to obtain a background check. If you already have a background check please attach it to this form or email us the copy. If you volunteered at a past event and already received your background clearance you do not need to get clearance again. We have it on record that you have been verified. **If you are volunteering and already have a fingerprint clearance card, please upload it to this form.***If you need to have your background checked, your cost is $12, please log on to Averity at:https://opportunities.averity.com/ASANowPlease note that you will need to provide your full name, social security, date of birth and email. You'll need a credit card to pay on-line. You may skip all other questions such as previous address by simply typing a few letters. You will receive a follow up email from Averity with your background information.On behalf of the foster parents, thank you so much for your support!
Do you have a current Level 1 Fingerprint Clearance Card & Background Check?*

Yes, I will upload belowYes, I am a previous volunteer and ASA Now has a copy on fileNo, I will obtain a background check through link provided aboveNo, I am a teen (under 18)
If yes, please upload documentation here:*

Browse Files
attach clearance card Cancelof
Do you have additional volunteers to register?*

YesNo

Volunteer Name #5

First NameLast Name
Birthday*

MonthDayYear
Date
Gender*
Are you over the age of 18?

YesNo
BACKGROUND CHECK:

Parents place an immense amount of trust in the person or people responsible for caring for their children. It is for that reason that we ask that all participating adults (age 18 and older) have a background check. We can assist you in obtaining a background check. Your cost is $12 and it is valid for two years. Please follow directions below to obtain a background check. If you already have a background check please attach it to this form or email us the copy. If you volunteered at a past event and already received your background clearance you do not need to get clearance again. We have it on record that you have been verified. **If you are volunteering and already have a fingerprint clearance card, please upload it to this form.***If you need to have your background checked, your cost is $12, please log on to Averity at:https://opportunities.averity.com/ASANowPlease note that you will need to provide your full name, social security, date of birth and email. You'll need a credit card to pay on-line. You may skip all other questions such as previous address by simply typing a few letters. You will receive a follow up email from Averity with your background information.On behalf of the foster parents, thank you so much for your support!
Do you have a current Level 1 Fingerprint Clearance Card & Background Check?*

Yes, I will upload belowYes, I am a previous volunteer and ASA Now has a copy on fileNo, I will obtain a background check at the above linkNo, I'm a teen (under 18)
If yes, please upload documentation here:*

Browse Files
attach clearance card Cancelof

Under 18 Information
Are any registered volunteers under the age of 18?

YesNo

Under 18 Parental Information
Parent's Name*

First NameLast Name
Parent's Email*
example@example.com
Parent's Phone Number*

Area CodePhone Number
By registering, I agree I will have a parent sign the Parent Permission Waiver and Release Form on the next page.*

I agree to the above.

Waiver and Release Form

* You must be 18 or older to sign this document.
PLEASE READ THIS DOCUMENT CAREFULLY; BY SIGNING THIS DOCUMENT, YOU ARE FREELY GIVING UP LEGAL RIGHTS.

THIS WAIVER MUST BE SIGNED BY THE PARTICIPANTS PARENT OR LEGAL GUARDIAN. BY SIGNING THIS FORM AND CHOOSING TO PARTICIPATE IN THE ACTIVITIES, YOU AGREE TO ITS TERMS AND YOU AGREE TO GIVE UP LEGAL RIGHTS. YOU HAVE THE OPTION TO CHOOSE NOT TO PARTICIPATE IN THE ACTIVITIES OR USE THE PREMISES

PARTICIPANT AGREEMENT, RELEASE, WAIVER, AND ASSUMPTION OF RISK - Click HERE to view waiver.
I have reviewed, understand, and agree to comply with the above terms*

I agree
ASSUMPTION OF RISK AND WAIVER OF LIABILITY RELATING TO CORONAVIRUS/COVID-19 - Click HERE to view waiver.
I have reviewed, understand, and agree to comply with the above terms*

I agree
GRANT OF RIGHT TO USE LIKENESS - Click HERE to view waiver.
I have reviewed, understand, and agree to comply with the above terms*

I agree
I acknowledge that I have read the above waivers and release, understand that I have given up substantial rights by signing it, and sign it voluntarily, without any duress or undue influence.*

I agree
Name of Adult Volunteer and/or "Minor's" Authorized Representative (if Volunteer "Minor" is under 18 years of age)*

First NameLast Name
Signature of Adult Volunteer and/or "Minor's" Authorized Representative (if Volunteer "Minor" is under 18 years of age) - I am of legal age and am freely signing this agreement. I have read this form and understand that by signing this form, I am giving up legal rights and remedies.*

Clear
Date Signed:*

MonthDayYear
Date
Should be Empty:

Volunteer Sign-up: Parents' Night Out -

BACKGROUND CHECK:

Emergency Contact During Event

Volunteer Team Interest

BACKGROUND CHECK:

BACKGROUND CHECK:

BACKGROUND CHECK:

BACKGROUND CHECK:

Under 18 Information

Under 18 Parental Information

Waiver and Release Form