VOLUNTEER APPLICATION

VOLUNTEER APPLICATION
CONTACT INFORMATION
Name

First NameLast Name
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone
Format: (000) 000-0000.
Email
example@example.com
Birthdate

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
How did you hear about Clarity Clinic?
Why would you like to volunteer at Clarity Clinic?
Emergency Contact
Phone
Format: (000) 000-0000.
Relationship
AVAILABILITY
Please check the appropriate days and times you are available. [Clinic Hours 9am-3pm Monday-Thursday]

Days of Week

Rows	Monday	Tuesday	Wednesday	Thursday
Morning \| 9-Noon
Afternoon \| Noon to 3

FREQUENCY [check all that apply]
Office Use
08.12.2026

PLEASE REVIEW AND SIGN BEFORE APPLYING
Positional Statements
To be involved with Clarity Clinic, all personal are required to sign an agreement to uphold each of the Positional Statements as stated. If you cannot agree to any part of the statements, stop the application process at this point and speak with a Clarity Clinic representative.
Abortion
1. It is Clarity Clinic's position that every abortion claims an innocent life. We do not provide or refer clients for abortions.
2. Clarity Clinic is painfully aware of the trauma surrounding pregnancies related to rape, incest, deformities of the developing child, and/or health risks to the mother. We exist, in part, to provide helpful intervention in such cases, but we do not find abortion to be either effective or morally acceptable as a method of reducing such trauma.
3. In those extremely rare cases where continued pregnancy is reasonably expected to precipitate the mother's immediate and literal death, we have been able to discover no clear biblical principle absolutely prescribing or recommending the act of abortion. In such cases, we encourage the parties involved to prayerfully consider the gravity of their decision and the merit of available alternatives. Furthermore, we commit ourselves to respect the decision of the parents and to provide whatever support is possible.
Birth Control
1. "Sex education" in our schools has concentrated heavily on birth control instead of self-control. Clarity Clinic believes that so long as people engage in sexual relationships outside of marriage, there will continue to be great numbers of unplanned pregnancies, sexually transmitted diseases and broken lives.
2. Clarity Clinic is working to reach young adults with the truth filled message that sex can only be safe and loving within the context of a permanent, marital relationship.
3. Clarity Clinic does not provide information on birth control and does not provide or refer clients for birth control.
Statement of Principle
1. Clarity Clinic is an outreach ministry of Jesus Christ through His church. Therefore, Clarity Clinic is committed to presenting the gospel of our Lord to women in crisis pregnancies – both in word and in deed. In keeping with this purpose, those who serve the agency as board members, staff, and volunteers are expected to know Christ as their Savior and Lord.
2. Clarity Clinic is committed to the highest degree of integrity in dealing with its patients, earning their trust, providing promised information and services, and avoiding any form of deception in its corporate advertising or individual conversations.
3. Clarity Clinic offers assistance free of charge and does not discriminate on the basis of age, gender, marital status, race, or religious preference.
4. Clarity Clinic provides accurate and complete information concerning prenatal development, abortion procedures and risks, and alternatives to abortion. Recognizing that abortion compounds human need rather than resolving it, this agency does not recommend, provide, or refer for abortions or abortifacients.
5. Clarity Clinic is committed to meeting a woman's need at the point of decision regarding an unplanned or unwanted pregnancy. Through emotional support and practical assistance, women may face the future with hope, and plan constructively for themselves and their babies.
6. Clarity Clinic supports adoption as an excellent alternative to abortion for women experiencing unplanned and unwanted pregnancies. A list of referrals to adoption agencies and attorneys is available for those who find parenting to be impossible at this stage of their lives. However, this organization does not initiate or facilitate adoption for our patients, nor do we receive payment of any kind from these agencies.
7. Clarity Clinic is committed to encouraging sexual abstinence among those who are single, and fidelity within a marriage relationship.
I have read and am in agreement with Clarity Clinic's Positional Statements.
Signature
Printed Name
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate

CLARITYCLINICPREGNANCY CENTER
BACKGROUND RELEASE FORM
(Required for all Applicants)
In connection with this application for employment, I understand that an investigative consumer report may be requested now, and in the future as terms of my continued employment. This report may include information pertaining to my character, education, work history, credit history, motor vehicle records, and criminal information contained within any government agency, Federal, State, or Local. This information shall include, but not be limited to, verified by any statements made on my application.
I hereby authorize all corporations, companies, credit agencies, educational institutions, persons, law enforcement agencies, military services, and former employers to release information they may have about me to Company or its agents, and do forever release them from any liability or responsibility for doing so to the fullest extent allowed by law from any claims arising from the requested information.
If required, I specifically authorize a credit report to be obtained on myself.
I recognize and agree that a copy or facsimile of this document shall be as valid as the original.
I recognize and agree that this release shall be valid for this and any future update reports requested.
According to the Fair Credit Reporting Act, I am entitled to know if employment is denied based on information contained in this report, and to receive, upon written request, a disclosure of the public record information as well as the nature and scope of the investigative report.
ALL FIELDS ARE REQUIRED TO BE COMPLETE BEFORE RETURNING:
Name

First NameMiddle InitialLast Name
Social Security Number
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Driver's License Number
State of Issuance
Current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please list any previous addresses you have had in the past 7years:
Previous Address 1

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Previous Address 2

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Previous Address 3

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please list any former names (I.e. maiden or otherwise) you have used in the past 7years:
SIGNATURE
DATE

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate

VOLUNTEER RELEASE AND WAIVER OF LIABILITY
This is a Release and Waiver of Liability executed in favor of Clarity Clinic, a nonprofit corporation, their directors, officers, employees, and agents (collectively known as "The Clarity Clinic").
The Volunteer desires to work as a volunteer for the Clarity Clinic and engage in the activities related to being a volunteer. The volunteer understands that the activities may include working in the Clarity Clinic offices, and working at special events.
The Volunteer hereby freely, voluntarily, and without duress executes this release under the terms below:
Release and Waiver
Volunteer does hereby release and forever discharge and hold harmless the Clarity Clinic and its successors and assigns from any and all liability, claims, and demands of whatever kind of nature, either in law or in equity, which arise or may hereafter arise from Volunteer's activities with the Clarity Clinic.
Volunteer understands that this release discharges the Clarity Clinic from any liability or claim that the volunteer may have against the Clarity Clinic with respect to any bodily injury, personal injury, illness, death, or property damage that may result from the volunteer's activities with the Clarity Clinic, whether caused by the negligence of the Clarity Clinic or its officers, directors, employees, or agents or otherwise.
Volunteer also understands that the Clarity Clinic does not assume any responsibility for or obligation to provide financial assistance or other assistance, including but not limited to medical, health, or disability insurance in the event of injury or illness.
Other
Volunteer expressly agrees that this release is intended to be as broad and inclusive as permitted by the laws of the State of Iowa and that this release shall be governed by and interpreted in accordance with the laws of the State of Iowa. Volunteer agrees that in the event that any clause or provision of this release shall be held to be invalid by any court of competent jurisdiction, the invalidity of such clause or provision shall not otherwise affect the remaining provisions of this Release which shall continue to be enforceable.
By signing below, the Volunteer has read, understood, and executed this Release as of the date written above.
Volunteer Signature:
Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Address:
Phone:
Format: (000) 000-0000.
Should be Empty:

VOLUNTEER APPLICATION

CONTACT INFORMATION

AVAILABILITY

Office Use

PLEASE REVIEW AND SIGN BEFORE APPLYING

Positional Statements

Abortion

Birth Control

Statement of Principle

CLARITYCLINICPREGNANCY CENTER

BACKGROUND RELEASE FORM

ALL FIELDS ARE REQUIRED TO BE COMPLETE BEFORE RETURNING:

VOLUNTEER RELEASE AND WAIVER OF LIABILITY

Release and Waiver

Other