HeartStrings Volunteer Application

HeartStrings Volunteer Application

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HeartStrings Volunteer Application

Name(Required)
MM slash DD slash YYYY
Address(Required)
MM slash DD slash YYYY
Gender(Required)
Availability(Required)
Please indicate on the dates selected above what hours you are available to volunteer.
How often are you able to volunteer?(Required)

Interests & Skills

Areas of Interest (check all that apply):
Skills (check all that apply):

References (list up to 3)

References
Please provide up to three of your reference’s name, relationship, and contact number.
Please provide the name, home phone, and cell phone number for the person to contact in case of an emergency.

Application Agreement Statement

For the safety and security of the children, families and staff of Children’s Hope Alliance, I understand and agree that my references will be checked, and prior to volunteering I will be subject to a criminal background check and other appropriate screenings. 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.
Application Agreement(Required)

Confidentiality Agreement

I understand that Children’s Hope Alliance protects youth and staff by keeping all information completely confidential and secure. I also understand and agree that it is my responsibility to support the established measures that safeguard such confidential information. At no time will I disclose any youth or staff information without prior approved authorization. I understand that violation of this confidentiality agreement may result in civil penalties and may result in my immediate dismissal.
Confidentiality Agreement(Required)

Media Release Agreement Statement

I give my permission to allow my name and/or photographs to be used by Children’s Hope Alliance for agency newsletters, public relations and fundraising purposes now or in the future.
Media Release Agreement Statement(Required)

Disclaimer for Volunteers Statement

I have no criminal convictions that would adversely affect my capacity and ability to provide care, safety and security for the children in residence. I have not abused or neglected a child. I have not had child protective services involvement that resulted in the removal of a child. I have not been a respondent in a juvenile court proceeding that resulted in the removal of a child. I have not abused, neglected or exploited a disabled adult. I have not been a domestic violence perpetrator.
Agreement to the Disclaimer for Volunteers(Required)

Discrimination Statement

I give my permission to allow my name and/or photographs to be used by Children’s Hope Alliance for agency newsletters, public relations and fundraising purposes now or in the future.

Questions?  Call or email to request more information about the list above, send an email to volunteer@childrenshopealliance.org.