Volunteer Application Form

VOLUNTEER APPLICATION

Thank you for your interesting in volunteering with Cedars! Please help us get to know you better by filling out this online application.
Profile:
Name *

First Name Last Name
E-mail *
Phone Number *

Area Code Phone Number
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Emergency Contact Information:
Name *

First Name Last Name
Phone Number *

Area Code Phone Number
Relationship to You *
Experience:
Please describe any related past volunteer or professional experiences
Please list an educational background, degree and/or certificates
Skills:
Please list any computer/ office skills
Please list any other special talents or skills
Volunteer Interests:
How would you like to dedicate your time and desire to serve? *

Weekly Activities Ongoing Positions Skill Sharing Done-In-A-Day/ Events
Please provide more specifics about what you would like to do:
Availability:

Please fill in the days and times that you are available to volunteer:

	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	Sunday
Time (s)

If you are interested in volunteering on a stpecific date(s), please list:
Would you like to be included on Cedars mailing list to learn more about events, volunteer opportunities and ways to get involved with Cedars?

Yes No
Reference 1:
Name *

First Name Last Name
Phone Number *

Area Code Phone Number
E-mail
Relationship
Reference 2:
Name *

First Name Last Name
Phone Number *

Area Code Phone Number
E-mail
Relationship
How did you hear about us?
Background Verifications:
Do you have proof of indentification (ie DL, Passport, School ID, State or Military ID, etc? *

Yes No
Do you have a current TB Test? *

Yes No
Volunteer Agreement:
We require that you read the information below and indicate your understanding and agreement to these terms by signing in the space provided. Thank you for your interest in Volunteering with Cedars!
Please Read Carefully and Sign Below:

I understand that Volunteering at Cedars is a privilege, and that my desire to serve must, at all times, be affirmed by Cedars through its screening process.

I understand that assignment to an unsupervised volunteer position requires that I provide two references and, depending upon requirements for the Volunteer assignment, may include verification of past employment, finger printing, criminal background check, and DMV report.
Name *

First Name Last Name
Signature *

Clear
Date *

Month Day Year
Volunteer Liability Release Form:
In consideration of my desire to serve as a volunteer for Cedars, I hereby assume all responsibility for any and all risk of property damage or bodily injury that I may sustain while participating in any voluntary relief effort, disaster exercise or other activity of any nature, including the use of equipment and facilities of Cedars.

Further, I, for myself and my heir, executors, administrators and assigns, hereby release, waive and discharge Cedars and its officers, directors, employees, agents and volunteers of and from any and all claims which I or my heirs, administrators and assigns ever may have against any of the above for, on account of, by reason of or arising in connection with such volunteer relief efforts or my participation therein, and hereby waive all such claims, demands and causes of action.

Further, I expressly agree that this release, waiver and indemnity agreement is intended to be as broad and inclusive as permitted by the State of California, and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.
I currently have no known mental or physical condition that would impair my capability for full participation as intended or expected of me.

Photographic Release
I authorize the use of my name, voice, photograph, likeness, performance and/or biography by Cedars, the Board of Directors and their officers, employees and agents in connection with any use of a product arising out my volunteer service for Cedars. I authorize Cedars to obtain and hold copyrights in such Program and products, and to edit my performance and materials in its sole discretion.

I understand that Cedars has no obligation to air or publish such Program and products, and that I will receive no monetary compensation for the rights granted herein. I understand and affirm that this Authorization and Release shall be considered consent to such use by Cedars under the provisions of State of California Statutes.

I, the undersigned, am at least 18 years of age or I am the parent or guardian of a participant who is less than 18 years of age. Further, I have carefully read the foregoing release and indemnification and understand the contents thereof and sign this release as my own, free act.
Name *

First Name Last Name
Signature (if under the age of 18 must be signed by a parent or guardian) *

Clear
Date *

Month Day Year
Confidentiality Agreement:
I. Purpose. The purpose of this Confidentiality Agreement is to protect the identity and privacy of the participants.

II.Confidential Information. Confidential client information should never be discussed in the presence of thirdparties, except under the Terms outlined below. Any files and/or documents containing confidential information should never be shared or released to third parties, except under the Terms outlined below.

Confidential information includes, but is not limited to, the following:
1.Identifying information about the client, including name, address or phone number;
2.Information relating to the client’s family;
3.Information regarding the client’s health status

III.Terms. By signing this Confidentiality Agreement, you agree to the highest ethical standards and to abide bythe following provisions:
1.All communications between Agency staff, volunteers, and clients are confidential.
2.The staff or volunteer shall not disclose confidential information to a third party without the client’s expressconsent to release such information.
3.The staff or volunteer shall not disclose confidential information to a third party without Agency’s knowledgeand consent.
4.I understand that as a staff or volunteer, I have a duty to keep client information confidential throughout my term as a staff or volunteer as well as after my employment or volunteer status ends.
5.I understand that my failure to abide by the terms of this Confidentiality Agreement may result in the termination of my participation as a staff or volunteer at the Agency.

I, the undersigned, am at least 18 years of age or I am the parent or guardian of a participant who is less than 18 years of age. Further, I have carefully read the Confidentiality Agreement and understand the contents thereof and sign this release as my own, free act.
Name *

First Name Last Name
Signature (if under the age of 18 must be signed by a parent or guardian) *

Clear
Date *

Month Day Year
* YOU SHOULD RECEIVE AN EMAIL AFTER COMPLETING THIS APPLICATION. Check your spam folder too.
Should be Empty:

VOLUNTEER APPLICATION

Profile:

Emergency Contact Information:

Experience:

Skills:

Volunteer Interests:

Availability:

Reference 1:

Reference 2:

Background Verifications:

Volunteer Agreement:

Volunteer Liability Release Form:

Confidentiality Agreement: