SUCCEED VOLUNTEER APPLICATION

SUCCEED VOLUNTEER APPLICATION
Full Name*

First NameMiddle NameLast Name
E-mail*
Date of Birth*

MonthDayYear
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number

Area CodePhone Number
Availability

MondayTuesdayWednesdayThursdayFridaySaturdaySunday
Typical Available Start Time

:HourMinutesAM/PM Option
Typical Available End Time

:HourMinutesAM/PM Option
How often are you available? Do you have any additional information regarding your availability?
How did you hear about A Chance to Change?
If other, please explain
What skills do you have that would be useful when volunteering?
Have you ever been convicted of a felony?

YesNo
Terms and Agreements

Please read through the below release and agreement information. Your signature is required before your application will be considered.

VOLUNTEER RELEASE

I attest and verify that I have knowledge of the risks that may be involved in my participation in various volunteer activities. By signature, and of free will, I do hereby agree to indemnify and save harmless A Chance to Change Foundation from any and all claims or demands, cost, or expense arising out of any injuries or damages sustained by me or any other party I am responsible for.

CONFIDENTIALITY AGREEMENT

Volunteers are responsible for maintaining the confidentiality of all proprietary or privileged information to which they are exposed while serving as a volunteer, whether this information involves a single staff, volunteer, client, or other person or involves overall agency business. All volunteers must understand they are to keep all information confidential at all times including after their service at a Chance to Change Foundation.

Volunteers will be held liable for such confidentiality as stated above. Failure to maintain confidentiality may result in termination of the volunteer’s relationship with A Chance to Change Foundation.

I AGREE TO GIVE MY COOPERATION IN FOLLOWING THESE RIGHTS AND EXPECTATIONS.

CONSENT FOR BACKGROUND CHECK

I hereby acknowledge that A Chance to Change Foundation has my permission to conduct a criminal background check through the Oklahoma State Bureau of Investigation if they should choose to do so. I understand that any findings that result from the background check that A Chance to Change Foundation find questionable gives the agency the right to deny me acceptance into their volunteer program.
I agree to the above terms and conditions associated with volunteering at A Chance to Change. I give my written consent for staff at A Chance to Change to conduct a criminal background check using my social security number.

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