Volunteer Application Form
Thank you for your interest in volunteering your time here at Genesis Center! Please fill out the following form so we can collect data and/or best match your strengths/availability with our needs.
First and last name
Emergency Contact Information
Name, relationship, phone number
How did you learn about the Genesis Center?
Is your interest in volunteering part of a requirement from an employer, university, or other entity?
Please indicate what your requirements are in the space provided.
Please provide dates indicating your length of commitment.
Select all that apply.
Select all that apply.
In what area would you like to volunteer?
Administration (finance & Human Resources, Development & Marketing, Office/Clerical, Maintenance)
Childcare (background check required)
Job Training Programs
Technology support in the classroom
Please describe any volunteer or work experience or expertise you have in the area in which you would like to volunteer.
Did you complete a volunteer orientation?
Release from liability:
I agree that, should I accept placement as a volunteer for Genesis Center, I will not hold Genesis Center liable in the event of personal loss or injury.
CONFIDENTIALITY AGREEMENT: Genesis Center is a non-profit organization dedicated to helping individuals and families in our community. Genesis Center requires all staff, consultants, and volunteers maintain the confidentiality of information collected, stored, or shared as part of its operations. Confidential information includes any information that may be used to identify an individual adult, child, program, school, or organization and that is not a matter of public record.All information regarding individuals, their diagnoses, and other medical information, academic records, assessments, and program placement is confidential. This information will only be shared with staff, consultants, and volunteers on a “need to know” basis. Furthermore, any documents containing such information will be handled prudently. All documents will bear the stamp “CONFIDENTIAL”, be retained for as brief a time as necessary, and then shredded through a professional service.The Genesis Center requires staff, consultants, and volunteers to submit a signed Agreement as part of its Confidentiality Policy. Please sign this form for our records. Thank you for your cooperation and for your efforts to safeguard any and all confidential information you may come in contact with in your work with Genesis Center.
I have reviewed the above Confidentiality Policy and agree to maintain the confidentiality of information as required.
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