Volunteer Service Application

Reference #1

First Name Last Name

Email

Phone

Reference #2

First Name Last Name

Non-Family Reference #2 Email

Phone

Optional Race/Ethnicity Information:

I choose not to disclose

Asian (Not Hispanic or Latino)

Black or African American (Not Hispanic or Latino)

Hispanic/Latino

Native American (Not Hispanic or Latino)

Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino

White (Not Hispanic or Latino)

Two or More Races (Not Hispanic or Latino)

Certification

Certification*

I certify that the information I have provided is true and correct to the best of my knowledge. I give my consent to my current and previous employers and persons given as references to respond to verbal and written requests for further information. Additionally, I understand that by checking the Accept box on this form, I am giving permission for a security check, including a social security and criminal background check to be run. I hereby pledge to treat any information pertaining to the families, staff, or volunteers of The Children’s Inn as personal and confidential. I understand that any breach of this confidentiality can result in immediate termination of my volunteer placement. The Children’s Inn volunteers have an ethical responsibility to protect the privacy of the residents and staff. Further, I voluntarily offer my services with a clear understanding that there will be no monetary compensation. I will be prompt and regular in my service. I will notify the appropriate person if I am unable to perform my volunteer duties as assigned. I agree to conform to all policies and regulations as applicable to The Children’s Inn. I understand that volunteers must be 18 years of age.

I Accept the Above Certification

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