This agreement and release of liability is between the Volunteer and TrueNorth Community Services, its employees, members, agents and affiliates, hereby referred to as “TrueNorth”. To the best of my knowledge, the information in this application is true and accurate. I authorize TrueNorth to disclose pertinent information to other agencies, organizations, churches or individuals for the purpose of sharing volunteer information.

Release of Information: I understand that my social security and driver’s license numbers will be required by the Central Records Division of the Michigan State Police for background checks to be conducted. I understand TrueMentors staff will collect needed information during the in-person interview. I authorize TrueNorth Community Services to contact references and to verify my employment. I hereby give my permission for the TrueMentors Program staff to share information which may include personal history, criminal history, driving history, mental diagnosis, and/or any other match relevant information with the parents/guardians of the child with whom I may be matched. Permission is also given to share relevant match information with other agencies, organizations, and/or individuals involved with either myself or the TrueMentors Youth I may be matched with. I further understand that a photocopy of the release will be considered as valid as the original.

Rejection Policy: It is the policy of TrueMentors to only accept volunteer applicants who will, in the professional opinion of the TrueMentors staff, provide an appropriate adult mentoring opportunity for an eligible child accepted into the TrueMentors Program. In the event that a prospective volunteer is not an appropriate fit for the specific needs of our program, the TrueMentors staff may decide to reject his or her application at any point during the enrollment process. For confidentiality purposes and because the intake process covers such an extensive amount of information, the applicant may or may not be told the reason for rejection. The prospective volunteer agrees to accept the professional decision as final.

Communications: I consent to the publication of my identity including photograph and name in TrueNorth Community Services and TrueMentors Program publications and advertising promotions. I release TrueNorth from any liability for use of images which include myself or family members generated for public relations including but not limited to: printed publications, pictures, videos, television, internet, and electronic media.

Liability Release: I agree to waive and release TrueNorth of any and all liability that could be incurred as a result of my negligence, intentional or unintentional, during my responsibilities as a volunteer for TrueNorth. I further release TrueNorth of all liability with regard to any physical or emotional harm that I may sustain during the tie I volunteer at TrueNorth or in any other activity sanctioned by TrueNorth. I agree to indemnify and hold harmless TrueNorth for any costs or liabilities which they may incur as a result of my volunteering at TrueNorth. As a volunteer and/or intern at TrueNorth, I will receive no financial reimbursement for services rendered.

Confidentiality: Through my volunteer work with TrueNorth programs and services, I will have access to information that is considered private. I acknowledge that this information must not be shared with others. In accepting this volunteer role with the agency, I agree to keep all information about program participants, staff, volunteers, and donors confidential. I will not copy, transcribe, record, or memorize confidential information for any reason other than for the limited purpose of providing the assigned services at TrueNorth.

I have had the opportunity to READ and UNDERSTAND this agreement and acknowledge that by signing this document, I am waiving certain legal rights in the event of injury. This agreement shall be governed by and construed in accordance with the laws of the State of Michigan.