Ada Jenkins Center

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I certify that all information in this application is true and complete. I understand that any false information or omission may disqualify me from further consideration for volunteer service and may result in my dismissal, if discovered, at a later date.

I understand, in consideration of my application, a background investigation will be conducted. I further understand that the investigation may include a reference check, a criminal background check, a sex offender registry check, and driving record check.

RELEASE and WAIVER of LIABILITY FOR ADULTS and MINORS:

The purpose of this release, waiver and confidentiality agreement is to protect the safety, well-being, and rights of all volunteers, staff, agents, partners, supporters, clients, and stakeholders of Ada Jenkins Center. Everyone who volunteers with Ada Jenkins Center is required to sign this agreement prior to beginning service with the organization. Please carefully read and fill-in information where necessary on the following agreement before signing.

Waiver and Release: I, the Volunteer or Guardian, do hereby release and forever discharge and hold harmless Ada Jenkins Center and its successors, Board of Directors, partners, sponsors, employees, agents and other volunteers, and assigns from any all liability, claims and demands of whatever kind or nature, either in law or in equity, which arise or may hereafter arise from Volunteer’s work for Ada Jenkins Center.

I understand that this Release discharges Ada Jenkins Center from any liability or claim that the Volunteer and/or Guardian may have against Ada Jenkins Center with respect to any bodily injury, personal injury, illness, death or property damage that may result from Volunteer’s work for Ada Jenkins Center, whether caused by the negligence of Ada Jenkins Center or its officers, directors, employees, or agents or otherwise. I also understand that Ada Jenkins Center does not assume any responsibility for or obligation to provide financial assistance or other assistance, including but not limited to medical, health or disability insurance in the event of injury or illness.

Confidentiality: I do hereby understand and acknowledge that during my tenure as a volunteer with Ada Jenkins Center, I may have access to Confidential Information not generally known to the public concerning the business of Ada Jenkins Center its client-partners. I do hereby agree that during my tenure as a volunteer with Ada Jenkins Center and all times thereafter, I will hold Ada Jenkins Center Confidential Information in strict confidence, and will not disclose or use such information outside the scope of my volunteer service with Ada Jenkins Center, or without Ada Jenkins Center’s prior authorization. For purposes of this Agreement, “Confidential Information” includes, but is not limited to, information regarding projects and potential projects, organizational practices, donors and potential donors, client-partners, methodologies, management philosophy, and information concerning Ada Jenkins Center employees and volunteers. I further agree that I will immediately return all Ada Jenkins Center Confidential Information at the end of my tenure as a volunteer, or whenever requested by Ada Jenkins Center. I understand that violation of this policy could result in the agency’s refusal to support me in the event of legal action, will lead to disciplinary action, up to and including termination of my service with Ada Jenkins Center and conviction by fines or by imprisonment or by both.

Volunteer Terms: I understand that the work for Ada Jenkins Center may include activities that may be hazardous to the Volunteer, including but not limited to, construction, loading and unloading and transportation to and from the work sites (including pickup and delivery of donations and transporting client-partners if applicable). I agree to abide by the Ada Jenkins Center’s policies and procedures. I understand the Ada Jenkins Center does not provide any health benefits (i.e. medical, dental, disability insurance, workers compensation, etc.) or any accident insurance for any Volunteer; it is the responsibility of the Volunteer and/or Guardian to provide this coverage. If, in the future, I become a client-partner I agree to notify my case manager of my volunteer role at The Center.

Background Certification: I certify that all of the information provided is true. Because the Ada Jenkins Center strives for a safe environment for children and adults, I understand that the Ada Jenkins Center may order a criminal history and sexual offender check, based on the program area for which I and/or the minor is volunteering, and I authorize this investigation. Volunteers will be notified and asked to authorize a background check prior to running the report.

Medical Treatment: I give permission for Ada Jenkins Center representatives to provide or arrange for emergency care for me or the minor, and to arrange for transport to an emergency center for treatment. I consent to medical treatment deemed immediately necessary or advisable by a physician if I am unable to act on mine and/or the minor’s behalf.

I do hereby release and forever discharge Ada Jenkins Center from any claim whatsoever that arises or may hereafter arise on account of any first aid, treatment or service rendered in connection with the volunteer work for Ada Jenkins Center or with the decision by any representative or agent of Ada Jenkins Center to exercise the power to consent to medical or dental treatment as such power may be granted and authorized in the Parental Authorization for Treatment of a myself and/or minor. Each Volunteer is expected and encouraged to obtain his or her own medical or health insurance coverage.

Property Loss: I understand the Ada Jenkins Center is not responsible for my personal property lost, damaged or stolen while participating in Ada Jenkins Center volunteer activities.

Photograph Release: I do hereby: consent that my and/or the minor’s photograph may be taken and image digitally recorded while engaged in work for Ada Jenkins Center and do hereby grant and convey unto the Ada Jenkins Center all right, title and interest in any and all photographic images, video, artwork, writing, or audio recordings made by the Ada Jenkins Center during the Volunteer’s work for Ada Jenkins Center, including but not limited to, proceeds or other benefits derived from such photographs, images, writing or recordings.