Neighbor to Neighbor Volunteer Application and Waiver

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This application and waiver is required of all volunteers in the Neighbor to Neighbor program. Please complete the questions below and you will be contacted by the Project Coordinator with next steps.

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First name: *

Last name: *

Street: *

City: *

State: *

Zip: *

Phone: *

Email: *

You will need a personal PIN to log your calls. Please enter a 4 digit PIN that you will remember that you will use if you are approved as a volunteer. Do not use a PIN that you use for any other accounts. *

Would you be willing to shop for, pickup and deliver pre-paid groceries for someone in need? *

Yes

I, the undersigned acknowledge that during the course of my volunteer senior citizen outreach work on behalf of the Village of New Paltz during the COVID-19 pandemic, I will be provided with certain personal and confidential information of village residents to which I would not normally be granted access, including, but not limited to, home and mobile telephone numbers. I hereby agree that I will keep all information to which I am granted access, whether or not such information is available through other public resources, strictly confidential and shall not disclose same to any person, organization or entity outside of the outreach program managers without the consent of the Village of New Paltz or the individual to whom the information applies. *

I agree

I disagree

I indemnify and hold the Village of New Paltz harmless for any violation of this agreement. *

I agree

I disagree

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