Volunteer Application and Waiver

Volunteer Application & Waiver

About You

Today's Date(Required)

Your Name(Required)

First Last

Your Address(Required)

Street Address Address Line 2 City ZIP Code

Your Email Address(Required)

Email Address Confirm Email Address

Your Phone(Required)

Date of Birth(Required)

Employer (If Applicable)

Emergency Contact Information

Emergency Contact Name(Required)

First Last

Relationship(Required)

Emergency Contact Phone(Required)

Emergency Contact Email(Required)

Volunteer Group Information

I am volunteering with a:(Required)

Group / Organization Name:(Required)

Are you 18 years or older?(Required)

Yes

I have reviewed the Glenwood Volunteer Policies & Procedures?(Required)

Yes

Waiver & Releases

All volunteers must review and agree to the following waivers and agreements. Please note that you will not be able to submit your application or volunteer at Glenwood without these agreements.

Liabitlity Waiver: I am agreeing to serve as a volunteer for Glenwood, Inc. I acknowledge and agree that activities performed by me as a volunteer will be performed strictly on a voluntary basis, without any pay, compensation, or benefits. I agree to comply with the rules and regulations established by Glenwood and failure to do so may result in my immediate removal as a volunteer. I am aware of the nature of the activities and people served to be performed as a volunteer and recognize and understand that there are certain risks inherent in working at any Glenwood facility, parking lot or at any offsite Glenwood events and I accept those risks. I agree that all volunteer activities are to be performed at my own risk. I understand that if an accident or injury should occur, no matter how minor, I will seek any necessary medical treatment using my own medical insurance. I will alert the Glenwood staff to the incident. I agree to indemnify and hold harmless Glenwood, Inc. its officers, Board of Directors, Junior Board of Directors, employees, agents and volunteers from and against any and all loss, damage, claims, liability, costs, and expenses of any nature whatsoever.(Required)

I agree

Media Waiver: I hereby consent and authorize any employee or agent of Glenwood, Inc. to take photographs, video, audio, webcast, or other types of media production that capture my name, voice, and/or image (here forth known as "materials"). I authorize Glenwood, Inc. to copyright the "materials" and I authorize Glenwood to edit, use, reuse, copy, publish, display, exhibit, reproduce, license to a third party, and distribute the "materials" in any promotional materials or forms of media, which may include but not limited to website, social media, newsletters, etc., and to offer the "materials" for use or distribution in other publications, electronic or otherwise without notifying me. I also agree that Glenwood, Inc. may identify me by name.(Required)

I agree

Confidentiality / Nondisclosure Agreement: I understand that in the performance of any duties as a volunteer or visitor, of Glenwood, Inc., I may have access to confidential information and be involved in the gathering or processing of such information, including proprietary, and client care information. Confidential client information includes all information, whether spoken, written or electronic, pertaining to a client, a volunteer, or visitor, and events surrounding the client’s care. I am aware that anything I learn or experience during my volunteer interaction which may be considered private, sensitive, or privileged information must be held in strict confidence. I agree that I will not share protected information, nor divulge identifying information regarding the clients, staff, or operations of Glenwood, Inc. or related individuals or entities. I understand that a failure to comply with confidentiality expectations may result in immediate termination of my volunteer relationship with Glenwood, Inc.(Required)

Yes

I hereby release Glenwood, Inc. and its agents and employees from all claims, demands and liabilities whatsoever in connection with the above.(Required)

Yes

Signature(Required)

Signature of Parent / Guardian if under 18 years of age