Volunteer Application

Rising Village Volunteer Application

First name

Last name

Cell Phone

Address

Birthday

Employer

Occupation

Gender

Male

Female

What is your current church membership or affiliation?

What languages do you speak? Please note fluency.

Educational background and professional training or degrees

Please describe any cross-cultural experience.

Please list any other volunteer experience you have.

Availability/Weekly availability (morning, afternoon, evening for each day of the week)

References

Name

Relationship to Applicant

Mission, Vision and Values

I have read the mission, vision, and values of Rising Village. I understand them and I desire to work with Rising Village to carry out the goals of the mission.

I personally affirm Rising Village's mission, vision, and values.

I do not personally affirm, but I agree to work alongside an organization who upholds these values.

Background Check

I understand that if my role involves close or unsupervised contact with vulnerable refugees, I must pass a criminal background check in order to volunteer with Rising Village.

Photography Release

I give Rising Village permission to photograph me and use such photos in Rising Village related publications without remuneration to me.

Yes

Financial Agreement

By selecting the "I Agree" option at the end of this form, I confirm that I do not expect any financial compensation for my services.

PSEA

Rising Village defines the term ‘sexual exploitation’ as any actual or attempted abuse of position of vulnerability, differential power, or trust, for sexual purposes, including but not limited to, profiting monetarily, socially, or politically from the sexual exploitation of another. The term ‘sexual abuse’ means actual or threatened physical intrusion of a sexual nature, whether by force, coercion or under unequal conditions. Rising Village has a zero-tolerance policy for exploitative and abusive relationships. Likewise, we will also not tolerate any actions that jeopardize employee security or the reputation of our organization. It follows, therefore, that interns and volunteers should have:

- No sexual contact with children under the age of 18 (mistaken belief of age is not a legitimate defense)

- No sexual contact with or intimate relationships with Rising Village beneficiaries/clients.

Acts of sexual exploitation and abuse will result in disciplinary action, up to and including dismissal.

By signing this form, I agree to act in a professional and ethical manner in accordance with the Sexual Exploitation and Abuse Code of Conduct.

Motor Vehicle Check

All interns/volunteers must have a valid driver’s license and pass a Motor Vehicle Records Check in order to operate a personal vehicle to transport clients. By signing this form, I confirm that I am covered by personal liability and property damage automobile insurance that meets the minimum state requirements. I understand that I am responsible for all damage and liability claims to my personal vehicle. I affirm that any vehicle I operate while interning or volunteering with Rising Village is owned by me or that I have express permission granted by the owner to operate this vehicle. I understand that if I permit anyone other than myself to operate my vehicle, I do so at my own risk and that my insurance may be implicated in the event of any injury or damage to property.

Yes

No (I will note be driving as part of my volunteer assignment)

Release of Liability

By selecting "I Agree," I confirm that I am aware of the potential risks to which I may be exposed during the assignment that I have voluntarily accepted with Rising Village. I understand my assignment with Rising Village and fully understand the potential risks of serving in this particular capacity. With such knowledge, I hereby indemnify and hold harmless Rising Village, and waive any and all legal claims against Rising Village for any injuries, direct and consequential damages, or loss that may result from my service, assuming all of such risk unto myself.

I agree

Health Policy

By signing this form, I confirm that I am aware that Rising Village clients or staff may have communicable diseases and I should use good hygiene practices when interacting with clients or staff. I recognize that client and staff health information is confidential, in accordance with state and/or federal law. Rising Village cannot disclose information regarding medical status unless legally authorized by the client or other legal authority.

I acknowledge that Rising Village may suspend volunteer activities in order to safeguard public health, and I recognize that I could become ill from communicable diseases encountered during Rising Village volunteer activities, despite practicing Good Hygiene Practices. I assume this risk in my role as a volunteer.

I understand that at any time, I may advise Rising Village that I will suspend volunteering due to my concerns regarding any communicable illnesses. I also understand that if I have any symptoms of illness, I am not permitted to volunteer in any capacity that involves contact with others.

I agree to the Health Policy

Confidentiality Policy

Volunteers are also responsible for maintaining confidentiality of all information they are exposed to while serving as a volunteer. This information may involve a single staff, volunteer, client, and others or involve overall program or agency business. Failure to maintain confidentiality shall result in termination of the volunteer relationship or appropriate corrective action.

I agree to the Confidentiality Policy

By checking this box I confirm all information is correct and agree to all policies as outlined above.