VOLUNTEER AGREEMENT AND CERTIFICATION OF INFORMATION
In the knowledge that The Children's Clinic, "Serving Children and Their Families" (TCC) has need of my services as a volunteer, I agree:
To hold as absolutely confidential, in compliance with HIPAA regulations, all information which I may obtain directly or indirectly concerning patients, parents, doctors, or TCC personnel, and will not seek confidential information in regards to a patient.
That my services are donated to TCC without contemplation of compensation, or future employment and given with humanitarian or charitable reasons.
Regular Volunteers: To commit a minimum of 30 hours and/or at least six (6) months of service.
My signature of below ceritifies that all statements made on this applications are true, complete and correct to the best of my knowledge. I understand these statements are subjection to verification and that falsification on this application can disqualify me from consideration or result in my volunteer services being denied. I release TCC and my former employers and all others from any liability from damage that may result from such an investigation, if, upon investigation, anything contained in this application is found to be untrue. I further agree to conform to the rules and regulations of this facility. I understand that my volunteer status at TCC can be terminated at any time for failure to comply with the policies, rules, and regulations of the organization; for absences without notification; for reasons of unsatisfactory attitude, work or appearance; and for any other circumstances which, in the judgement of TCC, would make my continued service as a volunteer contrary to the best interests of TCC. Furthermore, my signature below provides my authorization to TCC to conduct reference checks to determine my suitability for placement.
The Children's Clinic, "Serving Children and Their Families" (TCC) acknowledges that equal opportunity for all persons is a fundamental human value. Each volunteer applicant will be considered on the basis of individual ability and merit, without regard to race, color, age religion, national origin, disability, sexual orientation, sex, or marital status.
If you are under the age of 18, please continue filling out this application by clicking the 'Next' button. For those that are 18 and over, you may now submit the volunteer application.
PARENTAL CONSENT (to be completed if applicant is under the age of 18)
I give my consent for my child, named on page one of this application, to provide volunteer services to TCC. I also give consent to obtain any emergency medical treatment necessary for the safety of my child.