Summer Adult Volunteer Application
IMPORTANT NOTE: Due to COVID-19 we have suspended volunteering until further notice. However, in hopes that programs will resume in June, we are tentatively accepting summer volunteer applications. All trainings listed below will be hosted digitally via Zoom. You will receive more communication and information on May 18th, 2020.

Thank you for your interest in volunteering with ICAN. To volunteer you must complete the following application. The application will be filed and you will be contacted a week before our next orientation date that take place quarterly. The current scheduled orientation dates are:

Summer   -  May 21st, 2020 -4- 5:30 pm - Application due by May 15th
If this application has been submitted after May 15th you will be put on a waiting list to attend the June 4th, 2020- 4-5:30 pm orientation. Please keep an eye on your email.

We require a background check on all volunteers 18+ years of age. We will send you a Disclosure and Release form to turn in closer to your orientation date.

If you have any questions please contact the Philanthropy Manager Raven Jordan at Raven@icanaz.org or 480-874-7580.

NOTE: All information will remain confidential.
First Name Middle Initial *
Last Name
Birthday (Minimum age to volunteer is 15) *
MM
/
DD
/
YYYY
Address, City, State, Zip
Email *
Home Phone
Cell Phone *
Gender
Cultural Background
Schedule and Interests
Why are you interested in volunteering with ICAN? *
Days Available to Volunteer (Check all that Apply) *
Required
Frequency *
What shift are you able to volunteer? *
Please pick a back up shift in case 1st choice is over booked.
Clear selection
Comments reguarding your schedule?
Skills/ Interest (Check all that Apply) *
Required
What are your scheduled summer vacation dates?
Do you have a special interest or a special talents that you would like to teach the youth? (Examples- Music, Soccer Club, or STEM)
Work and Experience
Language Spoken Fluently
Highest Level of Education *
Current Employer *
Phone Number
Occupation/ Title *
List any experience you have working with children in a volunteer or work-related capacity. (Agency, Position, Dates and Description)
Emergency Contact
Please provide information to for an emergency contact.
Last Name, First Name *
Phone Number (List as many as possible Cell, Home, Work) *
Relationship to You *
Do you have Health Insurance *
Name of Health Insurance Agency
Physical Limitations
Mission Statement
ICAN provides free, comprehensive programs that empower youth to be productive, self-confident, and responsible members of the community.
RELEASE AND WAIVER OF LIABILITY
The undersigned hereby acknowledges and agrees as follows with respect to participating in activities in connection with ICAN’s Volunteer Program:
In connection with my voluntary involvement in activities undertaken for and with the participation and support of ICAN, a non-profit, 501©3 organization, I hereby agree, for myself, my heirs, assigns, executors, and administers to release and discharge ICAN, its officers and directors, employees, agents and volunteers from all claims, demands and actions from injuries sustained to my person and/or property as a result of my involvement in such activities, whether or not resulting from negligence, and I agree to release and hold ICAN, its officers and directors, employees, agents, and volunteers harmless from any cause or action, claims or suit arising therefrom. I hereby attest that my attendance and involvement in such activities is voluntary, that I am participating at my own risk, and that I have read the foregoing terms and conditions of this release. I also grant full permission for ICAN to use photographs of me and quotations from me in legitimate accounts and promotion of ICAN activities.
I hereby confirm, represent and warrant that I have never been convicted of, or charged with, a violent crime, child abuse or neglect, child pornography, child abduction, kidnapping, rape or any sexual offense, nor have I been ordered by a court to receive psychiatric or psychological treatment in connection therewith.
ACKNOWLEDGEMENT OF CONFIDENTIALITY
I acknowledge this responsibility and agree not to divulge any information that I have acquired due to my involvement in ICAN, either verbally, in print, or through any other means. This agreement also extends to the prohibition of any disclosures, although not individual specific, in which the identity of the children, their families, and/or staff persons may not readily be ascertained.
OPERATIONAL ACKNOWLEDGEMENT
I agree to accept all responsibilities of serving as a volunteer in the Program, notifying the Volunteer Coordinator of any cancellations or changes in my schedule. I understand and agree that I am enrolling in the volunteer program and that all of my responsibilities are subject to evaluation. I agree to document the hours spent as a volunteer with ICAN. I agree to respect the human rights and dignity of persons receiving services from ICAN and to work cooperatively with ICAN employees.
This document shall be deemed to have been executed in the state of Arizona and accepted according to all of the above terms and conditions.
Commitment
I understand that ICAN relies on volunteer support and that I am committing to volunteer for a minimum of six months.
I have read and understand the following. *
Date *
MM
/
DD
/
YYYY
Name *
Submit
Never submit passwords through Google Forms.
This form was created inside of ICAN. Report Abuse