• Volunteer with Colorado Health Network

  • Thank you for your interest in volunteering at Colorado Health Network. We’re excited that you’re here. We value your time, perspective, and willingness to support our community. Please complete this application and a Volunteer Coordinator or Human Resources representative will contact you.

  • Format: (000) 000-0000.

  • Emergency Contact

  • Format: (000) 000-0000.

  • Additional Information

  • Are you part of a service-learning project or completing mandated community service hours?
  • If yes, when do you need to complete your hours by?
     - -
    2 digit month, 2 digit day, 4 digit year
  • Do you have transportation?
  • If you have your own vehicle, do you have insurance, and would you be willing to provide a copy of valid insurance to allow you to drive on behalf of CHN?

  • Please note, volunteers are not obligated to drive and doing so is completely optional.

  • Which location would you like to volunteer with? (Select all that apply)*
  • Which program would you like to volunteer with? (Select all that apply)
  • Do you speak any languages other than English?
  • Have you volunteered with Colorado Health Network in the past?

  • Availability

  • What time of day are you available? (Select all that apply)
  • Approximately how long would you like to volunteer with CHN?
  • How many hours would you like to volunteer?
  • On a scale of 1 to 10 (1 = very low, 10 = very high) please rate yourself on the following: 
    Rows

  • (Please note, there are no right or wrong answers, and information only helps tailor training and placement.)

  • Colorado Health Network is an equal opportunity organization. All volunteers will receive consideration for involvement without regard to race, creed, color, national origin, gender, gender identity, marital status, sexual orientation, religion, ancestry, mental or physical handicap, HIV status or age.

    Email HR@coloradohealthnetwork.org with any questions.

  • Background Check Authorization

  • Volunteer positions at Colorado Health Network are contingent on an acceptable background check. Human Resources will order the background check upon receipt of this signed release form.  Internal HR staff will conduct the checks and request additional information from the volunteer as necessary. 

    The HR representative will notify the hiring and/or supervising manager regarding the results of the check as necessary. In instances where negative or incomplete information is obtained, the appropriate management and the Director of Human Resources will assess the potential risks and liabilities related to the job's requirements and determine whether the individual should be offered a volunteer position. If a decision not to select a volunteer is made based on the results of a background check, there may be certain additional Fair Credit Reporting Act (FCRA) requirements that will be handled by Human Resources in conjunction with the employment screening service (if applicable).   

    Background check information will be maintained in a file separate from the volunteer file for a minimum of five years. 

    Colorado Health Network reserves the right to modify this policy at any time without notice.  
     
    Nicole Tefft, Director of Human Resources 
    nicole.tefft@coloradohealthnetwork.org 

  • Please sign and date this form as your authorization to continue with our background check process.

  • (Date of Birth and Social Security numbers are necessary for background check. Volunteers MUST be at least 18 years of age to volunteer at CHN)

  • Date of Birth
     - -
    2 digit month, 2 digit day, 4 digit year
  • Date
     - -
    2 digit month, 2 digit day, 4 digit year

  • Volunteer Release/Hold Harmless/Consent

  • Waiver of Liability

  • I hereby release, indemnify and hold harmless Colorado Health Network, INC., its directors, employees, entities and all municipal agencies whose property and/or personnel are used, and other sponsoring or co-sponsoring agencies or individuals from responsibility for any injuries (including any injury caused by negligence) or damages I may suffer as a result of my participation as a volunteer for Colorado Health Network, INC.  I likewise release and hold harmless from liability any person transporting me to or from events or activities I am volunteering for on behalf of Colorado Health Network. 

    In the event I become injured or require medical assistance, I give my permission for medical care to be administered to me as deemed necessary by the staff and paramedics on site.  

  • Initials*

  • Communications Release

  • I also authorize the use of my likeness in photos or videos for use in future marketing collateral for The Colorado Health Network, INC. I hereby give to Colorado Health Network and their nominees, agents and assigns, my free and unlimited consent and permission, waiving all claims for any compensation by reason thereof or for damages by reason thereof, to use, publish, republish or exhibit in the furtherance of its work, with or without identification of me by name, the photographs or videos taken, and to disseminate statements referring to me in conjunction therewith if Colorado Health Network so desires and to authorize any newspaper, company or other organization to use, publish, republish or exhibit said photograph or video with or without identification of me by name and to publish or disseminate statements referring to me in conjunction therewith in the promotion of Colorado Health Network and any of its fund campaigns or any of its activities.

  • Initials*

  • I agree to all of the terms and provisions initialed above.

  • Date
     - -
    2 digit month, 2 digit day, 4 digit year

  • Confidentiality Notice

  • It is the obligation and the policy of The Colorado Health Network, INC, to maintain the confidentiality of all client/patient* information and to protect its clients’/patients’ right to privacy. 

    All client information is confidential and shall not be shared with individuals outside of the agency without expressed permission from the client/patient or parent/guardian. 
    While working on CHN premises as a volunteer or community partner, I understand that I may learn certain facts about a client that are of a confidential nature. Examples of such information: medical condition and treatment, finances, living arrangements, employment, sexual orientation, gender identity, and even the fact that an individual is a client of CHN. 

    I understand that all such information must be treated as completely confidential. Towards that end, I understand that I am not to dispense any information concerning a client or any written, verbal, or computerized information about a client to any outside source unless previously authorized as part of my work with CHN. Furthermore, I agree not to access, or remove from the agency’s premises, confidential documents, including those stored electronically, unless previously authorized as part of my work with CHN. 


    I understand that my violation of a client’s right to privacy through a breach of confidentiality on my part will be considered grounds for immediate termination of my volunteer position and that CHN may pursue appropriate legal recourse when necessary. 

    This confidentiality agreement is binding through the duration of and beyond of volunteering. I understand that violation of this confidentiality agreement may result in legal action against me. 

    *Client/patient: any person accessing CHN for services, including but not limited to: someone affected by HIV or AIDS; a caregiver, family member, significant other, and/or co-habitant of someone affected by HIV or AIDS; a financial donor or in-kind contributor; a volunteer; an individual seeking information and/or referral; or an otherwise concerned supporter. 

  • Date
     - -
    2 digit month, 2 digit day, 4 digit year
  • Should be Empty: