Recurring Payment

Volunteer Application
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Cell Phone Number*
Employer Information*

EmployerOccupation
Emergency Contact*

Full Name

Relationship

PhoneRelationship

Postal / Zip Code
Ethnicity

AsianBlack or African AmericanHispanic or LatinoNative American or Alaska NativeNative Hawaiian or Other Pacific IslanderWhiteTwo or more racesPrefer not to say
How did you hear about us?

WebsiteSpecial EventSocial MediaFriend or FamilyOther
Have you ever been convicted of a felony?*

YesNo
Please tell us about you. What are your passions, skills, and anything else you think we should know.
I would be interested in volunteering in the following areas:

Office / AdminCresson Pod Empowerment CenterFood PantryDriver / TransportationSpecial EventsUnited We Serve Community Days of ServiceI'm not quite sure.

Volunteer Availability

	Not available	Morning	Afternoon	Evening
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

Volunteer Release of Liability and Confidentiality Agreement
I name* the undersigned, hereby release and agree to hold harmless UNITED WAY OF HOOD COUNTY, its members, affiliates, and employees or executives of any and all liability that could possibly be incurred as a result of my negligence, intentional or unintentional, during my service as a UNITED WAY OF HOOD COUNTY volunteer. I further release and hold harmless UNITED WAY OF HOOD COUNTY, its members, affiliates, and employees or executives of all liability with regard to any physical or emotional harm that I may sustain during the time I volunteer at UNITED WAY OF HOOD COUNTY, or as a result of my participation in any project as a volunteer, or in any other activity sanctioned by UNITED WAY OF HOOD COUNTY.
Additionally, I agree to the following:*

My role is as a volunteer, and as such, I will receive no financial reimbursement for services rendered.I will bring to the attention of UNITED WAY OF HOOD COUNTY staff any concern of a legal nature.I recognize that any and all information shared with me as part of my duties as a volunteer is confidential and shall not be divulged to unauthorized individuals, agencies, or organizations.I will not copy, transcribe, record, or memorize confidential information of any kind, nor disclose or use such information for any purpose other than providing the assigned services at UNITED WAY OF HOOD COUNTY.
AGREEMENT shall be governed in accordance with the laws of the State of Texas. I have had the opportunity to read and understand the release and acknowledge that by signing the document, I am waiving certain legal rights in the event of injury. BY SIGNING BELOW, I accept and agree to the terms contained above.*

Powered by Jotform SignClear
Date of Signature*

MonthDayYear
Date
I parent name ,as legal parent/guardian of minor name agree with the above.
Legal Parent / Guardian Signature

Powered by Jotform SignClear
Date

MonthDayYear
Date

Authorization for Release of Information

Findings on background checks do not necessarily imply that the volunteer would not be accepted, but may make them ineligible for specific volunteer positions in accordance with different program requirements.
All Volunteer background checks include the following:
- State and national criminal background checks
- State and national Sex Offender Registry background checks
United Way of Hood County authorized personnel will retain all personal and private information contained in this document in a seperate file, locked area for safety and security. Regular office files will not contain background information or reports at anytime.
Name*

First NameMiddle NameLast Name
Other Names used (married, maiden, etc.)
Personal Information*

Social Security Number

Texas Drivers License

Date of BirthPlace of Birth

Postal / Zip Code
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please list any other places you have lived outside of Texas in the last 7 years.
I hereby authorize The Department of Public Safety and the Texas Department of Family and Protective Services to release to United Way of Hood County, any information concerning my driving record, criminal history records and arrest records. I hereby release United Way of Hood County, the Department of Public Safety and the Texas Department of Family and Protective Services, including all officers, employees or related personnel, both individually and collectively, from any and all liability or for damages of any type which may at any time result to me, my heirs, family or associates because of compliance with this authorization.*

Powered by Jotform SignClear
Date of Signature*

MonthDayYear
Date
I parent name ,as legal parent/guardian of minor name agree with the above.
Legal Parent / Guardian Signature

Powered by Jotform SignClear
Date

MonthDayYear
Date
Should be Empty:

Volunteer Application

Volunteer Release of Liability and Confidentiality Agreement

Authorization for Release of Information