Volunteer Release and Confidentiality Form

Volunteer Release and Confidentiality Agreement

Ronald McDonald House Charities of Southern Colorado

Thank you for completing RMHCSC's Volunteer Release and Confidentiality Agreement. This important form is required from all RMHCSC volunteers. Core Volunteers will need to renew it annually, and we’ll send you a reminder when it’s time.

Since RMHCSC is committed to protecting the privacy of our guests, please review the entire agreement carefully to understand your role in maintaining confidentiality.

Please select your reason for completing this form.*

I am in the onboarding process to become a Core Volunteer and have attended orientation.I am a Core Volunteer completing this form for a subsequent time.I will be preparing/serving a meal or baking.I will be volunteering with a GROUP to do something other than meals/baking.I will be volunteering for SERVICE HOURS.I will be utilizing the Kiwanis Community Room.I will be volunteering for a special event. (This does not include meals/baking/service groups.)I will be playing music for guests.
Is this form being completed for or by a minor under the age of 18?*

YesNo

Click on the section heading below to expand the section.

SECTION 1: To Be Completed by Minor Volunteer (under age 18)
Please read the following Volunteer Release and Confidentiality Agreement and check each box to indicate your consent.
First Name of Minor*
Under age 18
Last Name of Minor*
Under age 18
Email for Minor*
Email Address for Minor Volunteer (If minor does not have email address, email for parent/guardian is acceptable)
Date of Scheduled Service*

MonthDayYear
Date you're scheduled to make a meal, bake, do service hours, volunteer with a group, or volunteer for a special event.
Release of Liability
Confidentiality Agreement / HIPAA Compliance
Media Use Notice (Minor)
Core Volunteer Media Release Consent (Minor)
Core Volunteer Media Release (Minor): Core Volunteers can opt in or out of RMHCSC's media release consent. By opting in, Core Volunteers grant and convey to RMHCSC all right, title, and interests in any and all photographs, images, video, or audio recordings of their likeness or voice made by RMHCSC in connection with their providing volunteer services to RMHCSC.*

I consent to the media release.I do NOT consent to the media release.
Core Volunteer Photo (Minor)
To help us get to know our Core Volunteers, please upload a photo of yourself so that we can attach it to your volunteer profile in Volgistics. This photo will be used for internal purposes only unless you opt into the Core Volunteer directory.
Optional: Please upload a photo of yourself so that we can attach it to your volunteer profile in Volgistics. This photo will be used for internal purposes only unless you opt into the Volunteer Directory. If you uploaded a photo through this form in the past, you can skip this step.
Your photo must meet the following criteria:
- A headshot-style color photo
- Forward-facing, showing your waist and above
- Just you in the image
- File size of 5 MB or less
Tip: You can resize an image for free once at this Adobe website, or simply take a screenshot of your photo if needed. Thank you!
Upload your photo here.

File size must be less than 5mg. Please see the photo resizing tips above.
Cancelof
Core Volunteer Directory Consent (Minor)
You're invited to particpate in RMHCSC's digital and printable directory of Core Volunteers. This directory is shared with staff and fellow Core Volunteers only.

This directory helps Core Volunteers to connect with each other on a deeper level. It is updated monthly to accommodate new volunteers, and you can opt in or out at any time.

If you opt in, you’ll be giving us permission to share the following information about you in the directory:

First and last name
Cell phone number
Email address
Photo
Each time you complete this annual form, you will be invited to opt in or out of the Core Volunteer directory. If you opted in or out of the directory in the past, your reply today will superseed your previous reply.

The directory is shared with staff and fellow Core volunteers only and helps volunteers to connect with each other on a deeper level. It is updated monthly to accommodate new volunteers, and you can opt in or out at any time.

If you opt in, you’ll be giving us permission to share the following information about you in the directory:

First and last name
Cell phone number
Email address
Photo
Core Volunteer Directory (Minor): I consent to share my first and last name, my cell phone number, my email address, and my photo in RMHCSC's digital and printable Core Volunteer directory. This directory will be shared with staff and fellow volunteers only. I understand that I can opt in or out at any time.*

YesNo
Final Consent (Minor)
Signature of Minor*

Clear
Date*

MonthDayYear
Date

Thank you for completing section 1. Section 2 must be completed by the parent/guardian of the minor volunteer.

SECTION 2: To Be Completed by the Parent/Guardian of Minor
Please read the following Volunteer Release and Confidentiality Agreement and check each box to indicate your consent.
Parent/Guardian First Name*
First Name
Parent/Guardian Last Name*
Last Name
Parent/Guardian Email*
Email Address
Is the minor volunteer age 16 or 17?*

YesNo
Background Check Consent (Parent/Guardian)
Release of Liability (Parent/Guardian)
Confidentiality Agreement / HIPAA Compliance (Parent/Guardian)
Media Use Notice (Parent/Guardian)
Core Volunteer Media Release Consent (Parent/Guardian)
Core Volunteer Media Release (Parent/Guardian): Core Volunteers can opt in or out of RMHCSC's media release consent. By opting in, Core Volunteers grant and convey to RMHCSC all right, title, and interests in any and all photographs, images, video, or audio recordings of their likeness or voice made by RMHCSC in connection with their providing volunteer services to RMHCSC.*

I consent to this media release for my child.I DO NOT consent to this media release for my child.
IMPORTANT: Your child consented to the media release in section 1 above. Please discuss this with your child and adjust your response or their response so that the responses are the same.
Core Volunteer Photo
Core Volunteer Directory Consent (Parent/Guardian)
Your child has been invited to particpate in RMHCSC's digital and printable directory of Core Volunteers. This directory is shared with staff and fellow Core Volunteers only.

This directory allows Core Volunteers to connect with each other on a deeper level. It is updated monthly to accommodate new volunteers, and your child can opt in or out at any time.

If your child opted in, they've given us permission to share the following information about them in the directory:

First and last name
Cell phone number
Email address
Photo
Core Volunteer Directory (Parent/Guardian): I consent for my child's first and last name, cell phone number, email address, and photo to be shared in RMHCSC's digital and printable Core Volunteer directory. This directory will be shared with staff and fellow volunteers only. I understand that my child can opt in or out at any time.*

YesNo
IMPORTANT: Your child consented to participate in the Volunteer Directory in section 1 above. Please discuss this with your child and adjust your response or their response so that the responses are the same.
Final Consent (Parent/Guardian)
Parent/Guardian Signature*

Clear
Date*

MonthDayYear
Date of Parent/Guardian's Signature

Thank you! After you click on "Submit" below, a copy of the signed form will be emailed to you for your records.

To Be Completed by Adult Volunteer (over age 18)
Please read the following Volunteer Release and Confidentiality Agreement and check each box to indicate your consent.
First Name*
First Name
Last Name*
Last Name
Email*
Email Address
Date of Scheduled Service*

MonthDayYear
Date you're scheduled to make a meal, bake, do service hours, volunteer with a group, or volunteer for a special event.
Release of Liability
Confidentiality Agreement / HIPAA Compliance
Media Use Notice
Core Volunteer Media Release Consent
Core Volunteer Media Release: Core Volunteers can opt in or out of RMHCSC's media release consent. By opting in, Core Volunteers grant and convey to RMHCSC all right, title, and interests in any and all photographs, images, video, or audio recordings of their likeness or voice made by RMHCSC in connection with their providing volunteer services to RMHCSC.*

I consent to the media release.I do NOT consent to the media release.
Core Volunteer Photo
To help us get to know our Core Volunteers, we ask that you upload a photo of yourself so that we can attach it to your volunteer profile in Volgistics. This photo will be used for internal purposes only unless you opt into the Volunteer Directory.
Optional: Please upload a photo of yourself so that we can attach it to your volunteer profile in Volgistics. This photo will be used for internal purposes only unless you opt into the Volunteer Directory. If you uploaded a photo through this form in the past, you can skip this step.
Your photo must meet the following criteria:
- A headshot-style color photo
- Forward-facing, showing your waist and above
- Just you in the image
- File size of 5 MB or less
Tip: You can resize an image for free once at this Adobe website, or simply take a screenshot of your photo if needed. Thank you!
Upload your photo here.

File size must be less than 5mg. Please see the photo resizing tips above.
Cancelof
Core Volunteer Directory Consent
You're invited to particpate in RMHCSC's digital and printable directory of Core Volunteers. This directory is shared with staff and fellow volunteers only.

This directory allows Core Volunteers to connect with each other on a deeper level. It is updated monthly to accommodate new volunteers, and you can opt in or out at any time.

If you opt in, you’ll be giving us permission to share the following information about you in the directory:

First and last name
Cell phone number
Email address
Photo
Each time you complete this annual form, you will be invited to opt in or out of the Volunteer Directory. If you opted in or out of the Volunteer Directory in the past, your reply today will superseed your previous reply.

The Volunteer Directory is shared with staff and fellow volunteers only and helps volunteers to connect with each other on a deeper level. It is updated monthly to accommodate new volunteers, and you can opt in or out at any time.

If you opt in, you’ll be giving us permission to share the following information about you in the directory:

First and last name
Cell phone number
Email address
Photo
Core Volunteer Directory: I consent to share my first and last name, my cell phone number, my email address, and my photo in RMHCSC's digital and printable Core Volunteer directory. This directory will be shared with staff and fellow volunteers only. I understand that I can opt in or out at any time.*

YesNo
Final Consent
Signature*

Clear
Date*

MonthDayYear
Date

Should be Empty:

Volunteer Release and Confidentiality Agreement

Release of Liability

Confidentiality Agreement / HIPAA Compliance

Media Use Notice (Minor)

Core Volunteer Media Release Consent (Minor)

Core Volunteer Photo (Minor)

Core Volunteer Directory Consent (Minor)

Final Consent (Minor)

Background Check Consent (Parent/Guardian)

Release of Liability (Parent/Guardian)

Confidentiality Agreement / HIPAA Compliance (Parent/Guardian)

Media Use Notice (Parent/Guardian)

Core Volunteer Media Release Consent (Parent/Guardian)

Core Volunteer Photo

Core Volunteer Directory Consent (Parent/Guardian)

Final Consent (Parent/Guardian)

Release of Liability

Confidentiality Agreement / HIPAA Compliance

Media Use Notice

Core Volunteer Media Release Consent

Core Volunteer Photo

Core Volunteer Directory Consent

Final Consent