Faison Center Volunteer Application

Personal Information
Full Name*
Current Address*

Address

Street Address Line 2

City/State/ZipState / Province

Postal / Zip Code
Date of Birth*

MonthDayYear
Email Address*
Parent/Guardian Email Address (if under 18)
Phone Number*
Parent/Guardian Phone Number (if under 18)
Emergency Contact*
Name, relationship to applicant
Emergency Contact Phone Number*

Education/Employment Status
Current Status*

StudentEmployedUnemployedRetired
If you are a student, what school are you attending?
If you are employed, what is the name of your employer?
Are you a current Faison Center employee or have you worked for Faison in the past?*

YesNo
If yes, when and in what capacity?

Have you been convicted of any offense involving the sexual molestation, sexual battery, physical abuse, sexual abuse or rape of a child?*

YesNo
Have you been investigated by the Department of Social Services (Child or Adult Protective Services Unit) for abuse or neglect with a result of "founded?"*

YesNo
Have you been convicted of a felony and/or a misdemeanor?*

YesNo
If yes, please explain, and give dates of conviction, type of conviction, and jurisdiction where convicted
If you answered "Yes" to any of the above questions, The Faison Center may need to contact Child or Adult Protective Services before making a decision about your application. Do you grant The Faison Center the right to check with CPS/APS/Police regarding any of the above investigations and/or convictions? Anyone convicted of a misdemeanor or felony offense, especially an offense against a minor, may be disqualified from volunteering depending upon the nature of the offense and/or volunteer activity.*

YesNoN/A
A VOLUNTEER is defined as a person who has chosen to donate his/her time and talent, without compensation to assist with programs and activities at The Faison Center in an effort to enhance instruction and to promote learning opportunities. In conjunction with my voluntary involvement undertaken for and with the participation and support of The Faison Center, I hereby agree, for myself, my heirs, assigns, executors, and administrators to release and discharge The Faison Center, its officers and directors, agents, and volunteers from all claims, demands, and actions for injuries sustained to my person and/or property as a result of my involvement in such activities, whether or not resulting from negligence, and I agree to release and hold The Faison Center, its officers and directors, agents and volunteers harmless from any cause of action, claim or suit arising therefrom. I hereby attest that my attendance and involvement in such activities is voluntary, that I am participating at my own risk, and that I have read the foregoing terms and conditions of this release. I hereby grant The Faison Center the irrevocable right to use my name and likeness in any film, video tape, audio tape, photographs, slides, or combinations thereof, for inclusion in any promotional or advertising purposes, without any payment to me. By signing below I certify that the information provided in this application is true and correct to the best of my knowledge.
Signature*

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Date*

MonthDayYear
Date
Parent/Guardian Signature (If under 18)

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Date

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Date
During such times as I am a participant in The Faison Center volunteer program, I agree to assume full responsibility for such participation and release The Faison Center from any damages which I may sustain thereby. I fully understand that The Faison Center has the right to terminate my services at their sole discretion for any reason.
Signature*

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Date*

MonthDayYear
Date
Parent/Guardian Signature (If under 18)

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Date

MonthDayYear
Date
Should be Empty:

	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	Sunday
8AM - 10AM
10AM-12PM
12PM-2PM
2PM-4PM
4PM-6PM
6PM-8PM

Personal Information

Education/Employment Status

Volunteer Interests/Information