Volunteer Application Form

Name*

First NameLast Name

Date of Birth

Date

E-mail

example@example.com

Phone Number

Format: (000) 000-0000.

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Background Check Consent

I hereby authorize Hospitality In the Name of Christ, and any of its authorized representatives, to obtain information from the Michigan State Police ICHAT system pertaining to my criminal history or information that may make me unsuitable as a Volunteer.

I hereby authorize you to release such information upon request to Hospitality In The Name of Christ. This Authorization is executed with the full knowledge and understanding that the information is for official use by Hospitality In the Name of Christ.

I hereby release you, the organization in which you represent, including its members, both individually and collectively, from any and all liability for damages of whatever kind, which may at any time result to me, my heirs, family or associates because of compliance with this Authorization for Release of Information, or any attempt to comply with it.

This Authorization will continue in effect for 90 days from the date of signature.

Notice of Responsibility

By signing below, you acknowledge that any relationship or actions taken with a guest of the shelter outside of shelter activities are your personal responsibility. HospitalityINC cannot be held liable for any incidents that occur outside of shelter operations.

Email Consent

By signing below, you agree to be added to our contact list to receive our newsletter (3-4 per year) and any potential updates.

Photo/Video/Audio and Publicity Consent

Our shelter is equipped with video surveillance to ensure the safety of all guests and volunteers. Also, we take pictures and record video, by signing below, you acknowledge the presence of cameras and consent to being recorded in community areas where cameras are labeled. You also acknowledge that you may be photographed and agree that these photographs or any potential audio/video taken may be used on social media, our website, our newsletter, and other promotional materials.

Check here to Opt-Out of any photo/video/audio use.

YesNo

If yes, please list the date and reason for the background check.

Please list any other names that you have used (last/first/middle):

Agreement and Signature

I certify that the information in this application is true and complete to the best of my knowledge. I understand and agree to the terms outlined above.

Signature