Volunteer Application Form Application Date MaleFemaleName* Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home PhoneCell PhoneEmail* Group / Church NameI am 18 years of age or older.*YesNoDate of Birth* Month Day Year If you are under 18 years of age, please list your birth date above.*If volunteer is under 18, a parent/legal guardian's signature is required. OccupationEmployerVolunteer ExperienceHow did you hear about us?Education, Special Training, Interests, Hobbies, SkillsSpecial Certification (CPR, advanced driver’s license, medical, etc.)Languages spoken in order of fluencySkills InterestsCheck the following program(s) you would like to volunteer in: Cook/Meal Host Kid's Activities Program Reception/Administration Host a Drive (clothing, toys, needs list, etc) Food Bank (Daytime Hours Only) Thrift Store Other * Some Volunteer Opportunities require an interview and/or additional paperwork before startingInterests OtherAvailabilityWhy would you like to be a volunteer?I would like to volunteer... Occasionally Weekly Monthly Long Term List days/time frames of availabilityDo you have services hours that need to be completed?YesNoHow many service hours?When are the hours due?List agency (court ordered, school, etc)Have you ever been convicted of or plead guilty to any crime(s):YesNoDate If yes, describe in fullConviction Date Emergency Contact(s)Name* First Last Phone*Relation*Emergency Contact #2 - Name First Last PhoneRelationReferencesPlease include the name, relationship, phone, and email of 2 references below.Reference Name 1 First Last Reference Relationship (1)Reference Phone (1)Reference Email (1) Reference Name 2 First Last Reference Relationship (2)Reference Phone (2)Reference Email (2) VOLUNTEER GENERAL INFORMATION AND POLICIES San Fernando Valley Rescue Mission (SFVRM) an outreach of Rescue Mission Alliance (RMA) will not tolerate any form of harassment (verbal or physical) exploitation or intimidation of any nature from volunteers, interns, staﬀ members, program participants or guests. We are an emergency family shelter for homeless children and their parents. Please maintain a friendly but respectful and professional interaction with our shelter guests and clients. Do not assist any guest or resident with money, medication, gifts or transportation. Do not give out personal contact information, including email addresses or phone numbers. Should a guest or resident request to contact you personally, please report to the Volunteer Coordinator. Please be sensitive to the personal space of our guests (men, women and children). Ask permission before touching any guest or resident for any reason. DRESS CODE/SAFETY ISSUES Administrative volunteers may wear casual clothing appropriate for a professional business environment. All non‐administrative volunteers must wear closed‐toe and closed‐heel shoes. Wear modest clothing you are comfortable moving in and don’t mind getting a little dirty! All volunteers should be aware that by volunteering in any area assigned, you may be subjecting yourself to wet floors, sharp kitchen utensils, and all such related safety issues of that workspace, and if not careful could potentially result in bodily harm to you or others around you. SFVRM is not responsible for any accidents that may occur while you are volunteering at this facility or any of the offsite locations where we conduct outreach or special activities. GENERAL CODE OF CONDUCT RULES As a volunteer you represent SFVRM to the public. You accept responsibility for this status and will conduct yourself in a professional manner. You are expected to be clean and sober when participating as a SFVRM volunteer. You must maintain the confidentiality of all volunteers, clients, guests, residents and donors about whom you have personal or identifying information. You must not participate in and will report any and all instances of any sort of harassment, exploitation, and/or intimidation. You must maintain an atmosphere of physical and emotional safety for everyone associated with SFVRM including but not limited to employees, volunteers, clients, guests, residents and visitors. SFVRM is an organization assisting vulnerable men, women and children. No one who has ever been indicted or convicted of a violent crime, child abuse or neglect, child pornography, child abduction, kidnapping, rape or sexual offense may serve as a volunteer. As a volunteer, your activities may include potential hazards, including but not limited to (a) physical activity (including without limitation work with heavy tools and materials), (b) contact with unidentified and unfamiliar persons, (c) travel to and from various unspecified locations and (d) other potential risk of injury. You must be willing to provide volunteer service with the knowledge of the potential hazards involved and agree to accept any and all risks of injury without any recourse to or against SFVRM.Photo and Material ReleaseName First Last name of parent/legal guardian if the volunteer is a minorMinor's name (if applicable) First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country I, hereby give the Rescue Mission Alliance the absolute and irrevocable right and unrestricted permission concerning any photographs, videos, or audio recordings that are taken or may be taken of me or in which I may be included with others, to use, reuse, publish, and republish in whole or in part, individually or in connection with other material, in any and all media now or hereafter known, including the internet, and for any purpose whatsoever, specifically including illustration, promotion, art, editorial, advertising, and trade, without restriction as to alteration; and to use my name in connection with any use if they so choose. I release and discharge Rescue Mission Alliance from any and all claims and demands that may arise out of or in connection with the use of the photographs videos, or audio recordings, including without limitation any and all claims for libel or violation of any right of publicity or privacy. This authorization and release shall also inure to the benefit of the heirs, legal representatives, licensees, and assigns of Rescue Mission Alliance, as well as the person(s) who took the photographs, videos, or audio recordings. I am a legally competent adult and have the right to contract in my own name. I have read this document and fully understand its contents. This release shall be binding upon me and my heirs, legal representatives, and assigns. If subject is not yet (18) years old, the child’s parent or guardian must complete and sign the following:Signature*San Fernando Valley Rescue Mission Volunteer Agreement and Liability ReleaseI wish to volunteer for San Fernando Valley Rescue Mission (SFVRM) or its affiliates (together with RMA). I agree and release SFVRM as follows: I have read, understand and will observe SFVRM’s Volunteer General Information and Policies, as may be updated from time to time. I acknowledge that SFVRM is an organization assisting vulnerable men, women and children. I hereby confirm that I have never been indicted or convicted of a violent crime, child abuse or neglect, child pornography, child abduction, kidnapping, rape or sexual offense, nor have I ever been ordered by a court to receive psychiatric or psychological treatment in connection herewith. I understand that my activities as a volunteer may include potential hazards and risk of physical harm. I am voluntarily participating in this service with the knowledge of the potential hazards involved and hereby agree to accept any and all risks of injury without any recourse to or against SFVRM. I hereby release SFVRM, and the RMA, its directors, officers, partners, agents, employees, successors, assignees, licensees, sponsors, donors, representatives, guests and affiliates from all actions, claims, suits or demands that I, my assignees, heirs, guardians and legal representatives now have or may hereafter have arising out of, based upon or relating to my participation as a volunteer. I have carefully read this agreement, and the Volunteer General Information and Policies referenced herein, and fully understand their contents. I am aware that this is a release of liability and I sign it of my own free will. †Volunteer Signature*Parent/Legal Guardian SignatureFor volunteers under 18, a parent or legal guardian's signature is required† I acknowledge that I have been informed and am aware of the provisions of California Civil Code § 1542, which reads as follows: “A GENERAL RELEASE DOES NOT EXTEND TO CLAIMS WHICH THE CREDITOR DOES NOT KNOW OR SUSPECT TO EXIST IN HIS FAVOR AT THE TIME OF EXECUTING THE RELEASE, WHICH IF KNOWN BY HIM MUST HAVE MATERIALLY AFFECTED HIS SETTLEMENT WITH THE DEBTOR.” I expressly waive and relinquish all rights and benefits which I have or may have had under said section, and any similar provision of state or federal law. I further understand and acknowledge the significance and consequences of a specific waiver of Section 1542, and any similar provision of state or federal law, and hereby assume full responsibility for any damages or losses sustained by me of any sort or nature that might otherwise have been or are assertable as claims arising directly or indirectly out of, or relating to, this agreement, and any other aspect of my volunteer activities.PhoneThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle AJAX powered Gravity Forms.