BlessedGirl Volunteer Application

Contact Information
Name:
Street Address:
City, State and Zip Code:
Home Phone:
Work Phone:
Mobile Phone:
E Mail Address:
example@example.com
Availability

MondayTuesdayWednesdayThursdayFridaySaturdaySunday
When are you available for assigments?

Mornings (7AM-9AM)Mid-Day (10AM - 12PM)Afternoons (12PM - 5PM)Evenings (5PM - 10PM)
Interests: In which areas are you best suited to volunteer?

FundraisingSportsSummer CampBusiness and Social EtiquetteCommunications skills and techniquesFinancial LiteracyHealth/ WellnessMentoringTechnologyOther
Are you certified in?

First AidPediatric CPRCPRLifeguardNone
List Memberships in Clubs & Organizations:
List Hobbies & Special Skills:
Language(s) Spoken
Explain why you would like to be a Volunteer:
Previous Volunteer Experience:
Emergency Contact
Name*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Number

Area CodePhone Number
Work Number

Area CodePhone Number
Email
example@example.com
Agreement and Signature
By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a volunteer, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal.
Signature*
Date:

MonthDayYear
Date
BG Photo Waiver Release
I do not consent the use of photos/videos that contain my likeness.
I hereby grant the releasee permission to use photographs in any of the following:

Web-Based PublicationsPrint AdvertisementsOrganization BulletinSocial Media (e.g., Facebook, Twitter, Instagram, etc.)
I hereby affirm that such release to the releasee does not constitute any form of compensation, including royalties arising from the photographs/videos, to my benefit.

I understand and agree that photographs in the possession of the releasee shall become the property of the releasee. The use and publication of the photographs/videos however, shall conform to my rights as a subject of said photographs/videos.

I hereby waive my right to inspect of approve the photographs/videos by which my likeness appears.

I hereby hold harmless, release, and forever discharge the BlessedGirl from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.
Signature

Clear
Date

MonthDayYear
Date
Volunteer Background Check
Acknowledgment Form

*Nonemployment Background Checks Only*
Service to provide:
Date to Provide Service

MonthDayYear
Date
In order to ensure the protection of children in the care of BlessedGirl, our policy requires, prior to any and all persons providing a volunteer service or for any function conducted by BlessedGirl; all potential volunteers complete a background check. Any applicant declining to complete a 'Volunteer Background Check" acknowledgement form will not be considered.
Potential Volunteer Information
Full Name

First NameLast Name
Maiden Name or Other Names
Birth Date

MonthDayYear
Last 4 digits of SSN:
HISTORY INFORMATION
1) Have you volunteered for BlessedGirl before?*
2) Have you been hospitalized or treated for alcohol or substance abuse?*
3) Have you been accused of, arrested for, convicted of, or are you currently under investigation for a criminal offense excluding minor traffic violations?*
4) Have you been accused of, arrested for, convicted of, or are you currently under investigation for any sexually related crimes?*
5) Have you been accused of, arrested for, convicted of, or are you currently under investigation for any abuse related items?*
6) Are there any circumstances involving your life-style or your background that would call into question your ability to work with children?*
If you have answered yes to any of the above questions, please explain:
BlessedGirl reserves the right to “approve” or “deny” any volunteer service upon review of the background check returned. The determination will be based upon the individual’s fitness to have ponsibility for the safety and well-being of children. Providing false information, or information contradicting to the background check information, is grounds for immediate volunteer denial. By affixing your signature to this form you acknowledge your statements to be true and give full consent to complete the requested background check.
Signature*
Date Signed

MonthDayYear
Date
Questions or concerns, please email BlessedGirl at info@blessedgirls.com
Should be Empty:

Contact Information

Emergency Contact

Agreement and Signature

BG Photo Waiver Release

Volunteer Background Check

Potential Volunteer Information