Group Volunteer Application Form

Group Volunteer Application Form
Today's Date*

MonthDayYear
Date
Contact Name*

First NameLast Name
Name of Group & Address*

Group Name

Street Address Line

CityState / Province

Postal / Zip Code
Contact Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Contact Email*
example@example.com
Please let us know how many will be volunteering and what type of project you would like to do (ex. Cooking, Cleanup, Fundraiser)*
How did you hear about the Ronald McDonald House?*
Availability
SundayMondayTuesdayWednesdayThursdayFridaySaturday
9am-12pm12pm-3pm3pm-6pm6pm-9pm
Volunteer Pledge
- We will be on time and responsible in the fulfillment of my duties. We will accept supervision graciously.
- We will conduct myself with dignity, courtesy, and consideration.
- We will take all problems, criticisms, or suggestions to one of the managers of the Ronald McDonald House.
- We will endeavor to uphold the traditions and high standards of the Ronald McDonald House and will disseminate them to the community at large.
- We will try to do professional, quality work.
- We will consider any information which We may directly or indirectly hear concerning a guest or family as confidential information. We will not seek information in regard to a guest or family.
Signature* Date*
Commitment & Confidentiality, Hold Harmless, and Photo Release Agreements

Please check each item as your way of agreeing to the terms.
Our Group shall hold as absolutely confidential all information that we may obtain directly or indirectly concerning families or guests, and not seek to obtain confidential information from them.We understand that the Ronald McDonald House assumes no responsibility for any contact, visits, or services provided by our group members outside of the responsibilities assigned through the Group Volunteer Program of the Ronald McDonald House.Our group understands that if we are uncertain of anything while volunteering, Iwe can ask the Management Staff.
Our group and members understand that the Ronald McDonald House is involved with hospitals that accept patients with infectious and noninfectious diseases.Our group and members fully agree to indemnify and hold harmless the Ronald McDonald House for any unrecognized exposure to infectious diseases.The Ronald McDonald House strives to maintain a safe environment for volunteers, staff, visitors, and guests. In the event of exposure, a Ronald McDonald House staff person will contact all people who need to be informed that they were in contact with an infectious person and provide further steps for treatment and/or testing.Our group and members agree to adhere to all policies and regulations. We understand that any deviation from procedure may result in termination from privileges and/or volunteering at the Ronald McDonald House.
Signature* Date*
Health Attestation Statement
To ensure the safety, health, and well-being of all guests, families, staff, and volunteers at Ronald McDonald House, all volunteers must be physically and emotionally capable of serving in a hospital-adjacent environment.

By signing below, we acknowledge and attest to the following:

We are in good physical condition and able to safely perform the duties expected of a volunteer.

We are not aware of having any communicable illness or condition that could pose a risk to guests, families, staff, or other volunteers.

We understand that volunteering at Ronald McDonald House may involve interaction with families experiencing medical stress, crisis, or grief, and we affirm that we are emotionally able to participate in this environment.

We understand that if any member of our group has a medical condition, limitation, or concern that could affect their ability to volunteer safely, it is their responsibility to consult with a physician or qualified medical professional prior to participating.
We agree to follow all Ronald McDonald House policies, safety guidelines, and staff instructions while volunteering.

By signing below, we certify that the above statements are true and accurate to the best of our knowledge.
Signature* Date*
Inefction Control Safety Information
INFECTIOUS DISEASE NOTICE, RELEASE OF LIABILITY, AND ASSUMPTION OF RISK
(Group Volunteer Agreement)

To help ensure the safety and well-being of all guests, families, staff, and volunteers, Ronald McDonald House Scranton, Inc. maintains policies and procedures intended to reduce the spread of infectious and communicable diseases within its facilities and programs. Infectious diseases may be spread through person-to-person contact, airborne transmission, contact with contaminated surfaces, or other means.

While Ronald McDonald House Scranton, Inc. has implemented reasonable preventative measures, we understand and acknowledge that the organization cannot guarantee that any participant, guest, volunteer, staff member, or visitor will not be exposed to or become infected with an infectious disease while present at, volunteering for, or participating in any activity related to Ronald McDonald House Scranton, Inc.

Release and Waiver of Liability
On behalf of ourselves and all members of our group, we hereby release, waive, and forever discharge any and all liability, claims, demands, actions, or causes of action of whatever kind or nature against Ronald McDonald House Scranton, Inc., including, without limitation, its Directors, Officers, Employees, Agents, Representatives, and Volunteers (collectively referred to as the “Released Parties”), to the fullest extent permitted by law.

This release includes, but is not limited to, any claims for damages or losses caused in whole or in part by the negligence, fault, or conduct of any kind on the part of the Released Parties, including but not limited to death, bodily injury, illness, disease, economic loss, out-of-pocket expenses, or loss or damage to property, which we, the members of our group, our heirs, assigns, next of kin, or legal representatives may now have or may hereafter accrue arising out of or related to participation in volunteer activities, use of facilities, or involvement in any program or service of Ronald McDonald House Scranton, Inc.

Assumption of Risk
We acknowledge, understand, and agree to the following:

Participation in volunteer activities and use of the facilities may involve possible exposure to infectious or communicable diseases, including but not limited to respiratory viruses, influenza, COVID-19, RSV, tuberculosis, bacterial infections, and other illnesses. While safety procedures are in place, the risk of exposure, illness, serious complications, or death cannot be completely eliminated.

On behalf of ourselves and all members of our group, we knowingly and voluntarily assume all risks associated with such exposure or illness, whether known or unknown, and whether arising from the negligence or fault of the Released Parties or otherwise.

We further acknowledge that participation is voluntary, and we accept full responsibility for any injury, illness, loss, or damage that may occur in connection with our group’s participation, including any injury, illness, loss, or damage caused in whole or in part by the negligence or fault of the Released Parties.

Certification on Behalf of Group
By signing below, the undersigned certifies that they are authorized to sign on behalf of the group listed below and that all members of the group have been informed of and agree to the terms of this Infectious Disease Notice, Release of Liability, and Assumption of Risk.
Name: First Name* Last Name* Signature: Signature*
Date: Date*
Signature
Should be Empty:

Group Volunteer Application Form

Availability

Volunteer Pledge

Commitment & Confidentiality, Hold Harmless, and Photo Release Agreements

Health Attestation Statement

Inefction Control Safety Information