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VOLUNTEER WAIVER

By submitting this form, I attest that if a youth volunteer (under 18 years old), I have received the consent of my parent/guardian(s) and will be accompanied by an adult when volunteering at Coal Creek Meals on Wheels (CCMOW).

I understand and agree that my participation as a volunteer is completely voluntary. As a volunteer, I do not expect to receive, and understand that I will not receive, any salary, compensation, or payment of any kind whatsoever from CCMOW.

I understand and acknowledge that my participation as a volunteer at CCMOW may expose me to a risk of personal injury, including serious personal injury or death, and loss or damage to personal property. I hereby agree to release the individual members of CCMOW staff, officers, employees, members, sponsors, volunteers and Board of Directors, and hold harmless the above persons and organization, against any and all damages, claims, demands, rights, and causes of action of whatever kind and nature, based upon injuries or property damages to, or death of, any person (including without limitation any employee, invitee, resident, or other person), arising out of my participation in and volunteer work for CCMOW, either or off CCMOW facilities or the property or services provided therein or thereon, whether or not caused by any negligence of CCMOW, employees, volunteers, staff or Board of Directors.


CCMOW’s mission is to provide daily nutritious meals and related support services to members of our community in need, helping them to live with dignity in their own homes.  Quality of life for CCMOW consumers is improved by receiving a daily, nutritious hot meal delivered to their home and by daily contact with a caring volunteer. All donations received by CCMOW are contributions for which no goods and services shall be provided. Therefore, as volunteer, I will not receive any donations on behalf of CCMOW. CCMOW volunteers are expressly prohibited from offering merchandise sales, prizes, raffles, giveaways, lotteries, contests, tournaments, lucky draws, or any games of chance in exchange for donations either as an outright token action or as an inducement to solicit donations, unless such action is expressly authorized and sanctioned by the CCMOW board as part of an organized fundraiser.

As a CCMOW volunteer, I am limited to disseminating information that is to the benefit of CCMOW. CCMOW volunteers are expected to represent CCMOW in a professional manner in accordance with the organization’s policies and procedures. As a volunteer, I will not knowingly disseminate information that could be disparaging of or deleterious to CCMOW, Furthermore, volunteers are expressly prohibited from interacting with clients in a way that is inconsistent with CCMOW’s mission and values. Examples of prohibited subjects include, but not are limited to, the sale or promotion of any goods or services, an endorsement or perceived endorsement of any goods or services, support or opposition of a political party or a political candidate, materials affiliated with tobacco or tobacco-related products and any other products inconsistent with the CCMOW mission, content of any nature which may result in fraud or misrepresentation to the public, pornographic or otherwise offensive sexual materials, racially or ethnically prejudicial materials, overtly religious materials or any other information that may be offensive to the general public.

I agree to familiarize myself with CCMOW policies, procedures, and volunteer guidelines and to comply with both the letter and the spirit of these policies, procedures, and guidelines. I fully understand that the CCMOW expects high standards of moral and ethical treatment its clients. As a volunteer, I  agree to indemnify CCMOW for all fines, fees and expenses incurred as a result of the breach of any contractual obligations of the volunteer.

I give my full permission for such first aid as deemed necessary to be provided to me on the premises where I may be acting as a volunteer or prior to transport to a hospital for further treatment in the case of emergency while volunteering with CCMOW.    

BACKGROUND CHECK AUTHORIZATION

The volunteer position for which I am being considered requires me to consent to a criminal background check as a condition of volunteering. This check includes the following: criminal history reference searches for felony and misdemeanor convictions at the county and federal levels of every jurisdiction where I currently reside or where I have resided during the past 7 years.

I hereby authorize Coal Creek Meals on Wheels (CCMOW) to conduct the criminal background check described above. In connection with this, I also authorize the use of law enforcement agencies and/or private background check organizations to assist CCMOW in collecting this information.

I also am aware that records of arrests on pending charges and/or convictions are not an absolute bar to volunteering. Such information will be used to determine whether the results of the background check reasonably bear on my trustworthiness or my ability to perform the duties of my position in a manner which is safe for CCMOW clients, employees, volunteers and other community members.


           

First Volunteer's Name

First Name*

Last Name*

Phone*
First Volunteer's Date of Birth*
First Volunteer's Signature*
Second Volunteer's Name

First Name*

Last Name*
Second Volunteer's Date of Birth*
Third Volunteer's Name

First Name*

Last Name*
Third Volunteer's Date of Birth*
Fourth Volunteer's Name

First Name*

Last Name*
Fourth Volunteer's Date of Birth*
Fifth Volunteer's Name

First Name*

Last Name*
Fifth Volunteer's Date of Birth*
Sixth Volunteer's Name

First Name*

Last Name*
Sixth Volunteer's Date of Birth*
Seventh Volunteer's Name

First Name*

Last Name*
Seventh Volunteer's Date of Birth*
Eighth Volunteer's Name

First Name*

Last Name*
Eighth Volunteer's Date of Birth*
Ninth Volunteer's Name

First Name*

Last Name*
Ninth Volunteer's Date of Birth*
Tenth Volunteer's Name

First Name*

Last Name*
Tenth Volunteer's Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
Additional Items
I have reviewed the volunteer manual (www.coalcreekmow.org/volunteer-manual). *
Yes
I understand that I must maintain a current drivers license and auto insurance if my volunteer position involves driving, and I agree to provide copies upon request. *
Yes
I understand that I am not covered by Coal Creek Meals on Wheels' insurance policies when volunteering offsite. *
Yes
I hereby authorize Coal Creek Meals on Wheels (CCMOW) to conduct the criminal background check described above. *
Yes
I give my full permission for the use of my name and photograph in promotional materials. (Optional) *
Yes
No
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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