Project Homeless Connect 2026 - Volunteer Application

Name*

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email*

example@example.com

Phone Number

Please enter a valid phone number.

Are you 18 years of age or older?*

YesNo

Parent/Guardian Consent - Must be completed if volunteer is 16-17 years of age. I hereby consent for my minor child to be a volunteer with Crisis House. In regard to the above named youth volunteer’s participation, I HEREBYAGREE to release and hold harmless Crisis House, and its agents, employees and representatives of and from any and all liability of any kind or nature incurred by the above-named youth volunteer or by myself as the result of any act or failure to act, intentional or unintentional, by (1) any person who is not an agent, employee or representative of Crisis House or (2) any other volunteer. I also authorize Crisis House and it agents, employees or representatives into whose care the youth volunteer has been entrusted to consent to any x-ray examination, anesthetic, medical or surgical diagnosis or treatment and hospital supervision and upon the advice of a physician and surgeon licensed under the provisions of the Medical Practice Act or to consent to x-ray examination, anesthetic, dental or surgical diagnosis or treatment and hospital care to be rendered to the youth volunteer by a dentist licensed under the provisions of the Dental Practice Act.

Have you ever been charged with physical or sexual abuse of a child?*

YesNo

Have you ever been convicted by any court of a criminal offense?*

YesNo

Please list offenses giving date, location, nature and disposition for each.

Shirt Size*

Organization/Company

Volunteer Shifts (AM = 9a to 12p PM = 11:30a to 2:30p)*

I can volunteer all day (9a-2:30p)

Same selection as aboveWherever you need me

We will do our best to honor your choice, but made need to move volunteers around as needed.

General Consent

I understand that the information I provide may be verified, and I give permission to Crisis House to make an inquiry of others concerning my suitability to act as a Crisis House volunteer. I also understand that a personal reference or criminal background check may be completed if that action is deemed necessary. While volunteering for Crisis House, I may be dealing with confidential information, and I agree to keep said information in the strictest confidence. In consideration of being permitted to volunteer my services to Crisis House, I hereby agree to accept any and all risks of injury, damage or loss of personal property. The relationship between Crisis House and volunteers is an “at will” arrangement, and that it may be terminated at any time without cause by either the volunteer or Crisis House. I understand that I will not be paid an hourly wage, but that Crisis House can place an hourly value on my time in accordance with Independent Sector’s Value of Volunteer Time and that my volunteer hours may be used toward in-kind match for government funding.

Social Media Consent

I grant Crisis House permission to use my likeness, voice, photos and words in television, radio, file or in any form to promote activities of Crisis House.

I have read the General & Social Media Consent and am in agreement with its content.*