Volunteer Application

Name

First NameLast Name

Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Days Available

Preferred Hours

Why are you interested in volunteering for Mercy House International, Inc?

I am interested in the following areas (check all that apply)

Have you at any time ever

If Yes, explain

Reference (Not a relative) Name, Address Phone number, relationship

I recognize that Mercy House International, Inc (MHI) is relying on the accuracy of the information I provide on the MHI application form. Accordingly, I attest and affirm that the information I have provided is absolutely true and correct. I authorize MHI to contact any person or entity listed on the MHI volunteer application form, and I further authorize any such person or entity to provide MHI with information,opinions and impressions relating to my background or qualifications. I voluntarily release MHI and any such person or entity listed on the MHI volunteer application form from liability involving the communication of information relating to my background or qualifications. because of the nature of the MHI ministry, I further authorize MHI to conduct a criminal background investigation if such an investigation is deemed necessary. I agree to protect the health and safety of the residents and staff assigned to my care at all times. I understand that MHI will keep my personal information confidential and in a secure location for my protection.

I hereby understand and agree with the following statements: 1. My participation with Mercy House International Inc/1st Hand Seconds is a volunteer and not as an employee. 2. To assume all risks and liabilities that may result from my participation as a volunteer, and to release and forever discharge and hold harmless Mercy House International Inc/1st Hand Seconds, it's employees, representatives, and agents from any and all actions, cause of actions, claims, and liabilities arising out of injury to or damage sustained by me. 3. To indemnify Mercy House International Inc/1stHand Seconds against any and all liability or loss, and against all claims or actions arising out of damage or injury to persons and property caused by me; and, 4. As a condition of my being a volunteer, I will provide complete medical insurance coverage for any medical expenses that may be incurred because of my volunteer activities. Minor under 18 will need guardian signature.

I authorize Mercy House International, Inc/1st Hand Seconds to publish, copyright, and lawfully use any photographs or film footage of me and any statements to testimonials made by me as a volunteer.