Schreiber Circle Of Friends Academy Volunteer - OLD VERSION

I understand that this is an application and not a commitment or promise of volunteer opportunity. Please be advised that some positions may require the volunteer to produce current copies (within the past five years) of the PA Child Abuse History and Criminal Record History clearances. I give my permission to be photographed, videotaped, audiotapes, or interviewed while at the Center. This material may be used for future publicity of Schreiber including for use by the news media

 

I have read Policy 502-Notice of Privacy Practices and Policy 127-HIPAA Confidentiality and Security of Protected Health Information Compliance and have had an opportunity to have my questions answered regarding the Center's Confidentiality and Security of Protected Health Information policy. Confidential information, whether written, verbal, film, or electronic media, may be used or disclosed in a manner, which complies with these policies. I understand that I must comply with these policies and that failure to do so in any way will subject me to disciplinary action, up to and including termination of employment or opportunity to volunteer my services at the Center.

POLICY

Cellphone: Please refrain from using your cellphone in therapy sessions or classrooms as it can be a distraction for the children. If you must have your phone please have place it on vibrate and excuse yourself from the room to take a call.

Dress Code: It is the policy of Schreiber Pediatric to promote a professional image. Volunteers are expected to maintain a neat, clean, and well-groomed and to dress appropriately for your tasks. We ask that you wear conservative jewelry, because children can accidentally pull on big earrings, piercings and necklaces. We also ask that you wear close-toed shoes. Remember, this is a family-centered environment.

Inclement Weather: If the Center is closed for severe weather, it will be posted on WGAL under school closings. If you are unable to make it in because of inclement weather, kindly contact your supervisor.

Emergency Procedures: It is the policy of Schreiber to have a Safety Program with the purpose of creating a safe environment for staff, volunteers, and clients. In case of fire. as the alarm sounds return to your assigned department. If no smoke or fire is present, close all windows and doors while looking for other people in your area. Then use the nearest exit to evacuate the building and listen for directions from your supervisor. Evacuation maps are posted throughout the building.

• "Dr. Kid" is code for a missing child. In this situation, an intercom announcement will be made to identify the situation. All staff and volunteers should report to the front lobby area, where search assignments will be given. Upon finding the child, there will be an "all clear" intercom announcement.
• "Dr.Storm" is code for severe weather or a tornado alert. Should the President confirm a severe weather alert or tornado watch, volunteers are to follow the instructions provided by their supervisor.
• "Dr. Blue" is code for medical emergencies. If a medical emergency arises, the President or designee certified in First Aid will be notified. If assistance is needed, "Dr. Blue" will be activated to notify all staff and volunteers. The person who observed the incident will have to complete an Incident Report.
• "Dr. Armstrong" is code for an imminent physical assault in which a staff member will activate "Dr. Armstrong for assistance. Should 911 be called for police assistance, staff and volunteers will follow the directions from the police.
• "Condition Silver" is the code for an active shooter.

I have read the above information and understand what is expected of me as a volunteer at Schreiber Center for Pediatric Development.

As a Circle of Friends Academy Volunteer, I agree to the following:

• When dressing for your volunteer assignment, please wear comfy clothes, refrain from wearing perfumes or other scented lotions and be thoughtful about jewelry as little hands may grab.
• Upon arrival at the Center, please sign-in at the front desk.
• General Classroom Rules (Infant, Toddler, Pre-K)
  • Volunteers must follow the care plan provided for each child. Defer to childcare staff for specific information.
  • Volunteers cannot be left alone in the room.
  • Remember, some children take time to warm up to new faces.
  • Always follow the instructions of the childcare staff. Volunteers are there to help and be an extra set of hands for the staff.
• Specific Infant Room Rules
  • WASH HANDS UPON ENTERING THE ROOM
  • Take your shoes off before entering the room - our babies are on the floor. Feel free to bring slippers, socks or go barefoot.
  • Write your name on the white board so we know who is visiting.
  • Children may not be picked up by volunteers (this includes placing or picking up a child from a crib) Staff will hand the infant to the volunteer once seated.
  • Volunteers will not change diapers.
  • Volunteers may feed babies once food has been prepared by staff.

 

• I have reviewed the above information and understand that by not following the guidelines, my volunteer eligibility may change in the best interest of the children.

Required by the Child Protective Service Law
23 Pa. C.S. Section 6344 (relating to employees having contact with children; adoptive and foster parents)
I swear/affirm that, if providing certifications that have been obtained within the preceding 60 months, I have not been disqualified from employment as outlined below or have not been convicted of an offense similar in nature to a crime listed below under the laws or former laws of the United States or one of its territories or possessions, another state, the District of Columbia, the Commonwealth of Puerto Rico or a foreign nation, or under a former law of this Commonwealth.
I swear/affirm that I have not been named as a perpetrator of a founded report of child abuse within the past five (5) years as defined by the Child Protective Services Law.
I swear/affirm that I have not been convicted of any of the following crimes under Title 18 of the Pennsylvania consolidated statutes or equivalent crime under the laws or former laws of the United States or one of its territories or possessions, another state, the District of Columbia, the Commonwealth of Puerto Rico or a foreign nation, or under a former law of this Commonwealth.
Chapter 25 (relating to criminal homicide)
Section 2702 (relating to aggravated assault)
Section 2709.1 (relating to stalking)
Section 2901 (relating to kidnapping)
Section 2902 (relating to unlawful restraint)
Section 3121 (relating to rape)
Section 3122.1 (relating to statutory sexual assault)
Section 3123 (relating to involuntary deviate sexual intercourse)
Section 3124.1 (relating to sexual assault)
Section 3125 (relating to aggravated indecent assault)
Section 3126 (relating to indecent assault)
Section 3127 (relating to indecent exposure)
Section 4302 (relating to incest)
Section 4303 (relating to concealing death of child)
Section 4304 (relating to endangering welfare of children)
Section 4305 (relating to dealing in infant children)
Section 5902(b) (relating to prostitution and related offenses)
Section 5903(c) (d) (relating to obscene and other sexual material and performances) Section 6301 (relating to corruption of minors)
Section 6312 (relating to sexual abuse of children), or an equivalent crime under Federal law or the law of another state.
In addition to the crimes already outlined above, if I am an individual being employed in a child care center, group child care home, or family child care home, I swear/affirm that I have not been convicted of any of the following crimes under Title 18 of the Pennsylvania consolidated statutes or equivalent crime under the laws or former laws of the United States or one of its territories or possessions, another state, the District of Columbia, the Commonwealth of Puerto Rico or a foreign nation, or under a former law of this Commonwealth.
Section 2718 (relating to strangulation)
Section 3301 (relating to arson and related offenses)
18 U.S.C. Section 2261 (relating to interstate domestic violence)
18 U.S.C. Section 2262 (relating to interstate violation of protection order)
I swear/affirm that I have not been convicted of a felony offense under Act 64-1972 (relating to the controlled substance, drug device and cosmetic act) committed within the past five years.
I understand that I must be dismissed from employment if I am named as a perpetrator of a founded report of child abuse within the past five (5) years or have been convicted of any of the crimes listed above.
I understand that if I am arrested for or convicted of an offense that would constitute grounds for denying employment or participation in a program, activity or service under the Child Protective Services Law as listed above, or am named as perpetrator in a founded or indicated report, I must provide the administrator or designee with written notice not later than 72 hours after the arrest, conviction or notification that I have been listed as a perpetrator in the Statewide database.
I understand that if the person responsible for employment decisions or the administrator of a program, activity or service has a reasonable belief that I was arrested or convicted for an offense that would constitute grounds for denying employment or participation in a program, activity or service under the Child Protective Services Law, or was named as perpetrator in a founded or indicated report, or I have provided notice as required under this section, the person responsible for employment decisions or administrator of a program, activity or service shall immediately require me to submit current certifications obtained through the Department of Human Services, the Pennsylvania State Police, and the Federal Bureau of Investigation. The cost of certifications shall be borne by the employing entity or program, activity or service.
I understand that if I willfully fail to disclose information required above, I commit a misdemeanor of the third degree and shall be subject to discipline up to and including termination or denial of employment.
I understand that certifications obtained for employment purposes may be used to apply for employment, serve as an employee, apply to volunteer and serve as a volunteer.
I understand that the person responsible for employment decisions or the administrator of a program, activity or service is required to maintain a copy of my certifications.
I hereby swear/affirm that the information as set forth above is true and correct. I understand that false swearing is a misdemeanor pursuant to Section 4903 of the Crimes Code.