VOLUNTEER APPLICATION – Individual
First Name: ________________________ Cell Phone: ____________________________
Last Name: ________________________ Email address: __________________________
Street 1: ___________________________ Home Phone: ___________________________
Street 2: ___________________________ DL/State ID#: ____________________________
City: ______________________________ State: ____________ Zip: ____________
In the event of an emergency whom should we notify?
First Name: ________________________ Last Name: ________________________
Home Phone: ______________________ Work Phone: _______________________
Relationship: _______________________ Insurance Co. Name: _______________________
Policy #: ______________________ (optional)
We’d like to learn a few things about you!
Date of birth: _____ / _____ / _____ Gender: M or F Military Service: Y or N
Month Day Year
Citizenship: I am a US Citizen/Resident I am not a US Citizen/Resident
Language: English Spanish Other Fluent Language(s): __________________________
Skills: Administrative/Clerical Communications & Marketing Housing & Facilities
Logistics/Transportation Computers & IT Social Services
Food Service & Events Hobbies & Crafts HR
Trades Horticulture / Gardening Development
What inspired you to reach out and partner with us? ________________________________________
I have a comment/suggestion +/or story and I want to share! _________________________________
____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________
Email to: email@example.com
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PHOTO AND RELEASE, WAIVER OF LIABILITY, INDEMNITY AGREEMENT AND
UNIVERSAL PRECAUTIONS ACKNOWLEDGMENT
By my signature set forth below, I further authorize the P.E.O.P.L.E. Foundation or any of its agents, directors, officers, volunteers, servants to photograph, film and/or electronically record interviews with me in such manner as they choose.
The undersigned (Volunteer), for himself/herself, his/her personal representatives, heirs and next of kin, in consideration of being permitted to be a participant and/or volunteer of the P.E.O.P.L.E. Foundation, a Florida not for profit corporation, for related events and activities whether to be held on location or off site, the undersigned hereby agrees to the following:
1) The undersigned hereby releases, waives, discharges and covenants not to sue the P.E.O.P.L.E. Foundation, its directors, officers, employees, agents, affiliates and sponsored organizations, (hereinafter referred to as “releasees”) from liability to the undersigned, his/her personal representatives, assigns, heirs and next of kin for any loss or damage, and any claim or demands therefore on account of injury to the person or property or resulting in death of the undersigned, whether caused by the negligence of the releasees or otherwise, while the undersigned is in, upon, or about the any facilities therein, or arising out of the undersigned presence in, upon or about such premises for the purpose of the Foundation or the undersigned participation in any event.
2) The undersigned hereby agrees to indemnify and save and hold harmless the releasees and each of them from any loss, liability, damage or cost they may incur due to the undersigned being in, upon or about The P.E.O.P.L.E. Foundation or any facilities therein, or which may arise out of the undersigned presence in, upon or about such premises, for the purpose of any event or the undersigned participation in any event, whether caused by the negligence of the releasees or otherwise.
3) The undersigned hereby assumes full responsibility for and risk of bodily injury, death or property damage due to the negligence of the releasees or otherwise, in, about or upon the premises of The P.E.O.P.L.E Foundation or any facilities therein, or arising out of the undersigned presence, upon or about such premises for the purpose of any event.
The undersigned further expressly agrees that the foregoing release, waiver and indemnity agreement is intended to be as broad and inclusive as is permitted by law of the State of Florida and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full force and effect.
The VOLUNTEER further expressly agrees and acknowledges that volunteer has carefully read this agreement, knows of its contents, understands it, and voluntarily signs it, and further agrees that no oral representations, statements or inducements apart from the foregoing written agreement have been made outside this release and waiver of liability and indemnity agreement.
Infection Control – Universal Precautions Acknowledgment
When volunteering in a setting which caters to anyone including children with life-threatening illnesses, you may be at risk of exposure to infections. Please use the following guidelines while volunteering for the P.E.O.P.L.E. Foundation.
- Hand washing is the single most effective method of controlling infections. Wash your hands before, during and after your shift
- Always wear disposable gloves when required by the safety department in which you volunteer.
- Never perform tasks that require touching items of surfaces that are visibly soiled with blood or other bodily fluids.
- If you touch an item or surface soiled with blood or bodily fluids, wash your hands immediately with soap and water;
then report the instance immediately to the leader.
- Always report any potential hazard or possible hazardous incident to a lead person immediately.
Signed this ____ day of ____________, 20___, in ______________ County, _______________
Please print: __________________________ ____________________________________
P eoples’ E ffect on O ther P eople’s L ives E veryday
PO BOX 120365 ∙ Clermont, FL ∙ 34712 ∙ (407) 957-6969
Educational ∙ Empowerment ∙ Enrichment ∙ Encouragement ∙ Effect