Volunteer Interest Form VOLUNTEER’S INFORMATION First Name Last Name If applicable – Employer or Organization Preferred Phone Number Email Address Emergency Contact Name Emergency Contact Phone If you are under 18 years of age on the date you are volunteering, your parent or legal guardian must initial this form. I am at least 18 years old Parent/Guardian Initials Please read and confirm by checking all the following boxes: I confirm that I have not been named as a perpetrator of a founded report of child abuse/maltreatment nor am I currently under investigation or been convicted of a crime involving a child or a violent crime of any kind anywhere in the United States or its territories or possessions the District of Columbia the Commonwealth of Puerto Rico or a foreign nation. I understand that if I willfully fail to disclose any criminal background information, it will result in immediate denial of my application and complete revocation of my volunteer ability with the Partnership. I fully understand that the Partnership for Children of Cumberland Co. will immediately turnover any failure to disclose and/or violation of the law to authorities. I will ensure confidentiality and privacy for the people we serve. I will not disclose any information about a person to anyone outside of this organization. Disclosure can be made only under specified conditions for reasons relating to law enforcement or fulfillment of the mission and on a need-to-know basis. I agree to not take any photos or videos of clients being served or their children, nor will I share any images or videos on social media of clients or their children. I will not speak to any members of the media without the permission of the manager on duty. I give permission to the Partnership for Children of Cumberland County, Inc. and other news media entities, to prepare, reproduce, publish, or exhibit my or my child’s picture, portrait, or likeness for use by the news media or the Partnership in their news and public awareness programs. Any photograph, photo transparency, drawing, or other illustrative graphic material, audio‐visual tape, or audio‐visual illustrations, news report, story, or article may be used without my prior examination of the finished product. I hereby waive my (or my minor child’s right) to privacy in connection with consent below‐given and hereby release, discharge, and agree to hold harmless all the parties to whom this consent is given from any liability whatsoever and agree that this consent and waiver will not be made the basis of a future claim of any kind. I understand that if I willfully fail to follow these guidelines, I may be relieved of my volunteer duties immediately. I confirm that I am at least 18 years of age or a minor who has obtained written permission from my parent or legal guardian. Volunteer Interest Form VOLUNTEER'S INFORMATION First Name Last Name If applicable - Employer or Organization Preferred Phone Number Email Address Emergency Contact Name Emergency Contact Phone If you are under 18 years of age on the date you are volunteering, your parent or legal guardian must initial this form. I am at least 18 years old Parent/Guardian Initials Please read and confirm by checking all the following boxes: I confirm that I have not been named as a perpetrator of a founded report of child abuse/maltreatment nor am I currently under investigation or been convicted of a crime involving a child or a violent crime of any kind anywhere in the United States or its territories or possessions the District of Columbia the Commonwealth of Puerto Rico or a foreign nation. I understand that if I willfully fail to disclose any criminal background information, it will result in immediate denial of my application and complete revocation of my volunteer ability with the Partnership. I fully understand that the Partnership for Children of Cumberland Co. will immediately turnover any failure to disclose and/or violation of the law to authorities. I will ensure confidentiality and privacy for the people we serve. I will not disclose any information about a person to anyone outside of this organization. Disclosure can be made only under specified conditions for reasons relating to law enforcement or fulfillment of the mission and on a need-to-know basis. I agree to not take any photos or videos of clients being served or their children, nor will I share any images or videos on social media of clients or their children. I will not speak to any members of the media without the permission of the manager on duty. I give permission to the Partnership for Children of Cumberland County, Inc. and other news media entities, to prepare, reproduce, publish, or exhibit my or my child’s picture, portrait, or likeness for use by the news media or the Partnership in their news and public awareness programs. Any photograph, photo transparency, drawing, or other illustrative graphic material, audio‐visual tape, or audio‐visual illustrations, news report, story, or article may be used without my prior examination of the finished product. I hereby waive my (or my minor child’s right) to privacy in connection with consent below‐given and hereby release, discharge, and agree to hold harmless all the parties to whom this consent is given from any liability whatsoever and agree that this consent and waiver will not be made the basis of a future claim of any kind. I understand that if I willfully fail to follow these guidelines, I may be relieved of my volunteer duties immediately. I confirm that I am at least 18 years of age or a minor who has obtained written permission from my parent or legal guardian.
