Adult Volunteer Waiver

Adult Volunteer Waiver

Thank you so much for showing interest in volunteering with our Fifth Street Ministries community. Please complete the volunteer waiver below and contact Emily Bosshart with any questions you may have, contact@fifthstreetministries.com
* Indicates required question
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency contact name/relationship*
Emergency contact Phone number*
Please enter a valid phone number.
Are you volunteering with an organization, group, or church?*
If yes, please provide Group/Organization name.
In which area would you be interested in volunteering? (You may select multiple areas)

Packing & Distributing Community Food BoxesGrocery Store Pick-Ups (Using 5th Streets Transportation)AdministrationKitchen HelpVeteransPATH House ProgramMy Sister's HouseSpring Cleaning, Landscaping, Pressure washing (As needed)Donations (Sorting & Organizing)Other
If you'd like to look over the different volunteer areas, Click Here
When are you interested in volunteering? (You may select multiple options)*

MorningsAfternoonsEveningsWeekends
If you have children, under the age of 18 years, volunteering with you, please list their names below and fill out a youth application for each of them as well.
Any additional comments you'd like to add
Please read, check the boxes, and sign and date below
Liability Waiver: I am of legal age or the parent/legal guardian of the volunteer. I am freely electronically signing below that I understand and agree that Fifth Street Ministries is not responsible for any injury or property damage arising from volunteer activities. I hereby release Fifth Street Ministries, its officers, employees, and agents from any and all claims, damages, and liability, including any claims of medical expenses due to illness or personal injury and property damage from my participation in the volunteering.*

I agree
Confidentiality Policy: I am freely electronically signing below that I understand and agree to follow the confidentiality policy. All information concerning clients, former clients, our staff, volunteers, financial data, and business records of Fifth Street Ministries is confidential. "Confidential" means that you are free to talk about Fifth Street Ministries and your volunteer position, but you are not permitted to disclose client's names or talk about them in ways that will make their identity known. No information may be released without appropriate authorization. This is a basic component of client care and business ethics. The board of directors, staff, and our clients rely on paid and volunteer staff to conform to this rule of confidentiality.*

I agree
Publicity Release: Fifth Street Ministries has my consent to allow all photos, videos, digital media, and voice recordings for the organizations use. I hereby hold the organization harmless against any and all claims of damages arising out of taking or use of any pictures of said volunteer. I understand that I am not required to give this permission, and should I not agree, I will notify the volunteer coordinator upon arrival as well as anyone that may be taking pictures.*

Yes, Fifth Street Ministries has my consentNo, Fifth Street Ministries does not have my consent
Signature: *
Date*

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