Form C1: COVID-19 Volunteer Request Form
Please complete this form if you are interested in becoming a host organization for volunteers for your COVID-19 response efforts. Personal information submitted will be used only for communication and monitoring purposes. Rest assured that it will be treated with utmost confidentiality.

(Maaaring sagutan ang form na ito kung ang iyong organisasyon ay interesadong tumanggap ng volunteers para sa inyong pagtugon sa COVID-19 . Makakasiguro ka na iingatan at gagamitin lamang namin ang inyong personal na impormasyon para sa pakikipag-ugnayan at pagsubaybay sa mga gawaing tumutugon sa COVID-19.)


GENERAL INSTRUCTIONS
Please answer N/A if the question is not applicable. If you would like to provide additional information which cannot be captured by the questions, please include these under the " Additional Information" which can be found near the end of this form.

(Maaaring sumagot ng "N/A" kung hindi naaangkop ang tanong. Kung nais mong magbigay ng karagdagang impormasyon na hindi saklaw ng tanong sa bahaging ito, maari mong ilagay ang mga ito sa " Karagdagang Impormasyon" na matatagpuan malapit sa dulo ng form na ito.)
Name of Organization *
Complete Address (House No., Street, Subdivision, Barangay, City/Municipality, Province)
Block and Lot No./ Floor and Building No. *
Street/Subdivision *
Barangay *
City/Municipality *
Province (If the organization is based in NCR, please answer N/A.)
Region *
Classification (Klase ng Organisasyon) *
If others, please specify... (Kung iba pa, tukuyin...)
Government Agency where your organization is registered/accredited (Ahensiya ng pamahalaan kung saan rehistrado ang inyong organisasyon) *
Required
If others, please specify... (Kung iba pa, tukuyin...)
Year Established *
Head of Organization *
Volunteer Focal Person/Coordinator *
E-mail address *
Mobile/Tel. No. *
Website:
Facebook URL or username:
Other social media accounts, please provide organization’s username:
Volunteerism-related Information
Type of Volunteer Assistance needed by the Organization (Gawain o serbisyong kailangan) *
Required
If others, please specify... (Kung iba pa, tukuyin...)
Number of volunteers the organization needs: (Bilang ng Volunteers na kailangan) *
Duration of Volunteering Activity (Petsa o hanggang kailan ang gawaing boluntaryo?)
From:
MM
/
DD
/
YYYY
To:
MM
/
DD
/
YYYY
Basic Volunteer Qualification/s: ( Kwalipikasyon o Katangian ng volunteer na kailangan) *
Required
If others, please specify... (Kung iba pa, tukuyin...)
Minimum Volunteer Commitment:
Number of hours to be rendered by a volunteer in a day (Bilang ng oras na ibibigay ng volunteer sa isang araw) *
If others, please specify... (Kung iba pa, tukuyin...)
Number of hours to be rendered by a volunteer in a month (Bilang ng oras na ibibigay ng volunteer sa isang buwan) *
If others, please specify... (Kung iba pa, tukuyin...)
Location where volunteer assistance will be rendered: (Lokasyon kung saan magbibigay ng serbisyo)
Barangay *
City/Municipality *
Province
Region *
If others, please specify... (Kung iba pa, tukuyin...)
Incentives for Volunteers: (Ibibigay na insentibo/benepisyo para sa Volunteers) *
Required
If others, please specify... (kung iba pa, tukuyin...)
Link to sign-up form where volunteers can directly register, if any
Additional information regarding volunteer assistance needed: (Karagdagang impormasyon tungkol sa kailangang serbisyong boluntaryo ng organisasyon)
Declaration of Commitment of the Organization ( Salaysay/Panunumpa ng Pangako ng Organisasyon)
By completing this form, I declare that the information herein provided are true and correct. I hereby give my permission to the Philippine National Volunteer Service Coordinating Agency (PNVSCA) to disclose this information to volunteers, and the Technical Working Group for Anticipatory and Forward Planning created by the Inter-Agency Task Force for the Management of Emerging Infectious Diseases (IATF). As a requirement, I will also provide protective personnel equipment for the volunteers, if they are deployed in field activities.

With full knowledge and understanding, I accept any and all risks of damage, injury, illness, or death which may result from hosting the volunteers. I release and discharge PNVSCA, its officers and employees, from any claims for damages or injury and all liability arising out of my participation as a host organization.

I will also notify PNVSCA of whatever volunteer assistance I received as a result of this initiative.

(Sa pagsagot ko sa form na ito, pinatutunayan ko na ang mga impormasyong inilagay ko ay tama at totoo. Pinahihintulutan ko rin ang Philippine National Volunteer Service Coordinating Agency (PNVSCA) na ibigay ang aking impormasyon sa volunteers at sa Technical Working Group for Anticipatory and Forward Planning na naitatag bilang parte ng Inter-Agency Task Force for the Management of Emerging Infectious Diseases (IATF). Bilang requirement, magbibigay din ako ng personal protective equipment para sa volunteers kung sila ay ipapadala para sa field activities.

Kaakibat ng buong kaalaman at pang-unawa, tinatanggap ko ang maaring panganib na maidulot ng partisipasyon ko bilang host organization, kagaya ng pagkasira ng gamit, pinsala, sakit o kamatayan. Hindi ko rin papanagutin ang PNVSCA, kasama ng mga opisyales at empleyado nito, mula sa panganib na nabanggit.

Ipagbibigay alam ko rin sa PNVSCA ang ano mang serbisyong natanggap ko mula sa volunteers.)
Thank you for answering this form.
Later on, we will ask you to accomplish a report form where you can provide information on the volunteer assistance which you have received.
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