Volunteer Online Form | Warren Village

Date*
Date Format: MM slash DD slash YYYY
Full Legal Name*
First Last
Preferred First Name
Is Volunteer Over 18 Years of Age?*
- Yes
- No
How did you hear about us?*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Main Phone (home or cell)*
Work Phone
Email*
Name of Emergency Contact*
Phone for Emergency Contact*
Group/Organization you are volunteering with (if applicable)
Employer or School (if applicable)
Birth Date*
Date Format: MM slash DD slash YYYY

Waiver and Release
In connection with my voluntary involvement in activities undertaken for and with the participation and support of Warren Village, Inc., a non-profit charitable organization, I hereby agree for myself, my heirs, assigns, executors and administrators to release and discharge Warren Village, Inc., its officers and directors, employees, agents, and volunteers harmless from any cause or action, claim or suit arising therefrom. I hereby attest that my involvement in such activities is voluntary, that I am participating at my own risk, and that I have read the terms and conditions of this release.

I understand and will adhere to appropriate behavior relating to issues of confidentiality, professionalism, non- discrimination and appropriate boundaries in dealing with clients, staff and other volunteers. I will adhere to safe work practices and procedures. I will refrain from use of all illegal drugs and abuse of all legal drugs while performing my duties as a Volunteer. I waive my right to privacy in the information, which I voluntarily provided, and agree to the use of my photograph and the photographs of my children for the publicity and public relations purposes of Warren Village, Inc.

I authorize Warren Village to investigate my background, including, but not limited to any criminal charges, proceedings, or convictions, personal references, whether obtained from national, state, or local databases or authorities.

I agree to hold harmless and to waive any and all claims I may have against Warren Village and its agents, employees, or other volunteers for any and all loss or injury I may sustain as a result of them investigating my background in accordance with this release. I also agree to hold harmless and to waive any and all claims I may have against any person who provides information to Warren Village in connection with the investigation of my background, for any and all loss or injury I may sustain as a result of any disclosure made in accordance with this release. I understand that this includes the possible rejection of my application as a volunteer.

I hereby confirm, represent and warrant that I have never been convicted with a felony*, violent crime, child abuse or neglect, child pornography, child abduction, kidnapping, rape or any sexual offense, nor have I been ordered by a court to receive psychiatric or psychological treatment in connection therewith.

All of the information that I provide during the course of the application process is complete and accurate to the best of my knowledge. I understand that misrepresentations or omissions are grounds for rejection of the application or dismissal as a volunteer.

DO NOT ACKNOWLEDGE UNTIL YOU HAVE READ THE ABOVE STATEMENT
Signature
Use your mouse to sign your name.
Date Accepted
Date Format: MM slash DD slash YYYY
Parent/Guardian Signature
Date Accepted by Parent/Guardian
Date Format: MM slash DD slash YYYY
Please speak with our Volunteer Department if you have any questions about felony charges and volunteer eligibility.

Volunteer Agreement
As a volunteer assisting with the programming, residents, and staff of Warren Village I acknowledge the following responsibilities to make the Warren Village program and my volunteer experience more successful:
- I understand that my term of volunteer service requires a longer term commitment. For example:
  - A minimum of two (2) hours per month
  - Regular recording of volunteer hours in the log book or online
  - Complete necessary safety training or other alternate training required by the department in which I am volunteering.
  - A valid email address that is checked frequently
- I agree to work under the supervision of the assigned staff member or department supervisor in which I am volunteering and to perform my duties and responsibilities to the best of my ability.
- I will maintain confidentiality guidelines as it pertains to the participant or volunteer, only discussing details with the necessary staff. Failure to do so may result in termination from my volunteer position and subsequently the volunteer program.
- I will notify Volunteer Services or the supervising staff member if there is anything that may interfere with the success of my criminal background check.
- I will not seek to give counsel or legal advice at any time.
- I will not exchange or handle funds of any kind on behalf of Warren Village.
- I will not drive a program participant in my personal vehicle, unless otherwise instructed by Warren Village staff.
- I understand that if I can no longer fulfill my commitment to volunteer, I must notify my supervisor and Volunteer Services of my termination as soon as possible.
- Respectful of boundaries for staff, residents, and children.
- Warren Village maintains the right to terminate volunteers from service.
Signature
Date Accepted
Date Format: MM slash DD slash YYYY
Parent/Guardian Signature
Date Accepted by Parent/Guardian
Date Format: MM slash DD slash YYYY

Volunteer Code of Ethics
Mission
Warren Village exists so that previously homeless, single parent families can achieve sustainable personal and economic self-sufficiency.

As a volunteer of Warren Village, I dedicate myself to carrying out the mission of Warren Village and will do the following:
- Recognize that the chief function of Warren Village at all times is to serve the best interests of our constituency.
- Conduct my volunteer duties with positive leadership exemplified by open communication, creativity, dedication and compassion.
- Serve with respect, concern, courtesy and responsiveness in carrying out the organization’s mission.
- Demonstrate the highest standards of personal integrity, truthfulness, honesty and fortitude in all my activities in order to inspire confidence and trust in my activities.
- Avoid any interest or activity that is in conflict with the conduct of my volunteer duties.
- Respect and protect privileged information to which I have.
Compliance, Monitoring and Reporting
Warren Village management is responsible for communicating this Code of Ethics to all staff volunteers and for ensuring its adherence at all times.
Ratified by Warren Village’s Board of Trustees on Sept. 27, 2012
This form must be accepted by volunteers upon their joining the organization. The undersigned, by their acceptance, accept and agree to abide by the Volunteer Code of Ethics.
Signature
Date Accepted
Date Format: MM slash DD slash YYYY
Parent/Guardian Signature
Date Accepted by Parent/Guardian
Date Format: MM slash DD slash YYYY

Volunteer Confidentiality Agreement
I understand that as a volunteer I have access to confidential information about participants and systems. I agree to respect the confidential nature of the participant information I have access to and respect the rights to confidentiality for all participants that I come in contact with.

I understand that law protects a participant’s privacy. I understand that breach of confidentiality is a breach of law, to include:
- Discussing names, identities or any other information of participants with anyone other than Warren Village staff.
- Discussing the above in an area where you may be overheard by others.
- Any discussion of events of situations that may violate the protection of the participant’s right to privacy.
- Do not share photos of staff or residents without permission.
I understand that breach of participant confidentiality will result in immediate dismissal from my role as a volunteer at Warren Village.

By signing this Volunteer Confidentiality Agreement, I hereby agree to maintain participant confidentiality.
Signature
Date Accepted
Date Format: MM slash DD slash YYYY
Parent/Guardian Signature
Date Accepted by Parent/Guardian
Date Format: MM slash DD slash YYYY

Volunteer Media Release
I hereby give Warren Village permission to use my picture for:
Please Choose*
- All uses listed below
- Brochures
- Newsletters
- Slideshow Presentations
- Video
- Television
- Facebook or social media sites
- No photos/none of the above
Signature
Date Accepted
Date Format: MM slash DD slash YYYY
Parent/Guardian Signature
Date Accepted by Parent/Guardian
Date Format: MM slash DD slash YYYY

Volunteer Application

Step 1 of 8

Demographic Information (used for statistical reporting only):

I am interested in volunteering in the following areas:

Waiver and Release

Volunteer Agreement

Volunteer Code of Ethics

Volunteer Confidentiality Agreement

Volunteer Media Release