Volunteer

VOLUNTEER APPLICATION

Thank you for your interest in volunteering to assist seniors with completing projects around their homes and property. Please complete and electronically sign at the end of this form for the Application, the Media Release and Release of Liability Waiver. If a volunteer is under 18 then only an authorized parent or legal guardian can sign the application below.

APPLICATION DATE

Are you completing this form on behalf of yourself or for your child under 18?
MyselfMy ChildBoth

ADULT VOLUNTEER NAME

DOB

YOUTH VOLUNTEER NAME

DOB

ADDRESS

PHONE

EMAIL

EMERGENCY CONTACT NAME

PHONE

WHY ARE YOU INTERESTED IN VOLUNTEERING FOR CARE?
Tell us about what inspired you to contact us. Are you interested in supporting older adults and supporting the community? Do you need volunteer hours for school or work? Do you enjoy helping to keep the neighborhoods well maintained? Do you have a personal connection?

VOLUNTEER OPPORTUNITIES
Volunteer opportunities are dependent on the unique needs of the senior members we serve; however, the most common areas are yard care, exterior cleaning, minor painting and handy person projects. In addition, we may have opportunities for fundraising, volunteer engagement, and administrative. Service times are for up to 2 hours each with no maximum per year. CARE serves seniors in 9 cities: Cleveland Heights, Highland Heights, Lyndhurst, Maple Heights, Mayfield Heights, Mayfield Village, Richmond Heights, Solon, South Euclid.

APPLICATION AGREEMENT
We appreciate you taking the time to complete the application and are looking forward to you joining our Volunteer team. To ensure that we have a mutual understanding of the general expectations of being a CARE volunteer, the following information is being provided in advance. If you have any questions, please do not hesitate to ask us. If you understand and agree to the information outlined here, please sign below.

As an individual volunteer of Communities Assisting Residential Elders (CARE), I understand and acknowledge that the purpose of CARE is to provide volunteer services to assist adults who are 60+ and homeowners who live in Cleveland Heights, Highland Heights, Lyndhurst, Maple Heights, Mayfield Heights, Mayfield Village, Richmond Heights, Solon and South Euclid. I agree to only complete services that are assigned to and accepted by me in advance. As an individual volunteer I am not representing any specific company or organization. I agree not to solicit members (aka clients) for business or personal gain and that there will be no exchange of money or gifts between myself and any CARE member. I understand that all information pertaining to members (current, former or potential) is strictly confidential and agree to hold in confidence any information about members, which comes to my knowledge during my association with CARE. I agree not to solicit confidential information from members or other volunteers.

I hereby release CARE, its directors, staff and agents from any and all claims, responsibility, liability, or causes of action, for any injury, loss, or damage that I may incur in connection with my volunteer activities at CARE.

I understand that due to the nature of CARE providing services to the elderly, I may be required to participate in a background screening including a fingerprint scan for a BCI/FBI background check. I understand that for any volunteer who will be entering a member’s home or providing technical assistance, or certain administrative duties, a background check is required. CARE utilizes a third party to complete the background check and the specific information received is for internal purposes only and is not shared with members, other volunteers or for any purposes not related to my volunteering for CARE.

I agree to comply with CARE guidelines, processes and procedures during the duration of my volunteer service. I understand and agree that either party may terminate this volunteer relationship at any time and that submitting this application does not imply a guarantee to volunteer or approval by CARE to be a volunteer.

This application and terms outlined has no expiration date and remains in effect during and after my role as a volunteer or until a new application issued by CARE is required to be signed. This signed application replaces any previously signed applications. I am at least (18) years of age and fully competent to sign this application on my own behalf or on the behalf of my underage child. I understand that I have a right to seek legal advice in advance of signing this document.

AUDIO-PHOTO-VIDEO MEDIA RELEASE FORM
I grant permission to Communities Assisting Residential Elders (CARE) and its agents or employees to use photographs and/or video and audio taken of me. These images may be used in educational and documentary materials such as Public Service Announcements, Grant Applications, Video Documentaries and both printed and online newsletters. Furthermore, I authorize the use of my image, likeness, and voice for all program promotion, materials, and any other purposes in connection with the program deemed appropriate and necessary by CARE.

I hereby agree to release, defend, and hold harmless CARE and its agents or employees, including any firm publishing and/or distributing the finished product in whole or in part, whether on paper, via electronic media, or on Web sites, from any claim, damages, or liability arising from or related to the use of the photographs/video, including but not limited to any misuse, distortion, blurring, alteration, optical illusion, or use in composite form, either intentionally or otherwise, that may occur or be produced in taking, processing, reduction, or production of the finished product, its publication, or distribution.

This release has no expiration date and remains in effect during and after my role as a volunteer or until a new release issued by CARE is required to be signed. This signed release replaces any previously signed releases. I am at least (18) years of age and fully competent to sign this release on my own behalf or on behalf of my underage child. I understand that I have a right to seek legal advice in advance of signing this document.

AGREE OR DECLINE
Agree to Media ReleaseDecline Media Release - but still want to volunteer
CARE PROGRAM LIABILITY RELEASE AND WAIVER
This is a binding Release of Liability made by the Volunteer to the Communities Assisting Residential Elders (CARE) program, 1370 Victory Drive, South Euclid OH 44121. I am at least eighteen (18) years of age and fully competent to sign this Release on my own behalf or on behalf of my underage child. I execute this release for full, adequate, and complete consideration fully intending to be bound by the same. I acknowledge that I am participating in an event, activity or unpaid experience sponsored in part by the CARE Program (the “Agency”). I fully recognize that there are risks to which I may be exposed to by participating in this activity, event or volunteer experience which may include, but are not limited to, accident or injury.
I agree to assume on my own behalf, all of the risks and responsibilities in any way associated with this activity, event or experience. In consideration of and return for the services, facilities, experience and any other assistance provided to me by the CARE Program in this activity, I release, waive, forever discharge and covenant not to sue the Agency, its employees, administrators, board members, agents and insurers (“Releases”) from any and against all liability, claims, demands, actions, causes of action, costs and expenses of any nature which may occur or which may hereafter accrue to me arising out of or related to any loss, damage or injury that may be sustained by me or by any property belonging to me. I understand that this Release covers liability, claims and actions caused entirely or in part by any acts or failures to act of the Agency (or its board, employees or agents), including but not limited to negligence, mistake, or failure to supervise by the Agency while participating within any stage of this activity.
I understand that the Agency does not have medical personnel available at the location of the event, activity or experience. I understand and agree that the Releasees are granted permission to authorize emergency medical treatment, if necessary, and that such action by Releasees shall be subject to the terms of the Agreement. I understand and agree that Releasees assume no responsibility for any injury or damage that might arise out of or in connection with such authorized emergency medical treatment. I recognize that this Release means I am giving up on my behalf, among other things, rights to sue the Agency, its employees, administrators, board members, agents and insurers for injuries, damages or losses I may incur. I also understand that this Release binds my heirs, children, executors, administrators, and assigns, as well as myself.
LEAD WARNING STATEMENT– Housing built before 1978 may contain lead-based paint. Lead from paint, paint chips and dust can pose health hazards if not taken care of properly. Lead exposure is especially harmful to young children and pregnant women. It is not recommended that children or pregnant women participate in painting projects in homes built prior to 1978. Others who wish more information on safe practices for work with lead based paint should request literature.
I have read the Application Agreement, Media Release and the Liability and Waiver in their entirety, understand them and agree to be legally bound by them. I understand that I have a right to seek legal advice in advance of signing this document.
ELECTRONIC SIGNATURE
AUTHORIZED SIGNER - Enter your name
SIGNATURE DATE

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NAME

PHONE

EMAIL

YOUR MESSAGE

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