Application For Volunteer Service At The Palestine Ymca Form (Page 4 of 5) in pdf

Palestine YMCA

THE YMCA’s POSITION ON THE

NATION-WIDE PROBLEM OF CHILD ABUSE

WE MAKE AN ACTIVE EFFORT TO PREVENT CHILD ABUSE

Some examples may include, but are not limited to:

A thorough background check, including but not limited to, references of past employers, personal references,

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the military, educational institutions, volunteer organizations, civic groups, personal character, health and

activities .

Allegations or suspicions of child abuse are taken seriously and will be reported to the State for investigation

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Programs are structured so that no staff member is left alone with children

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Periodic interviews/evaluations with children and parents about day to day experiences, encouraging reports of

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anything out of the ordinary.

Staff and volunteers will not fraternize with children outside, the programs, including baby-sitting or inviting

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children home.

Testing for illegal substances.

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Psychological testing.

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Criminal history records check.

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YMCA goals:

To support and strengthen the family unit.

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To help children develop to their fullest potential

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To deliver the program in a positive YMCA environment of safety, support and care.

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PLEASE READ CAREFULLY BEFORE SIGNING

I hereby certify that the information provided on this

If, in the event I choose to cease volunteering, I am free

application is accurate to the best of my knowledge and

to do so at any time.

subject to verification by the YMCA. I authorize the

I also understand that, if selected to volunteer, any

schools, persons, previous employers, agencies and

misrepresentation made by me completing this

other organizations named in this application to provide

application shall be considered as sufficient cause for

the YMCA (its authorized employees, agents or

my dismissal without advance notice.

representatives) with any relevant information that may

be required to arrive at a volunteer placement decision

I authorize the YMCA to supply my volunteer record, in

and hereby release any such schools, persons,

whole or in part, and in confidence, to any prospective

employers, agencies and organizations from any and all

employer, government agency, or other party, with a

liability which they might otherwise incur as a result. I

legal and proper interest.

understand that any misrepresentation or omission of a

In the event of my selection, I will comply with all rules

material fact on my application may be justification for

and regulation as set forth by the YMCA. I have read,

refusal for placement.

understand and support the YMCA's position on the

I hereby give my permission for the YMCA to obtain

problem of child abuse.

information relating to my criminal history record. I

I understand that completion of this form does not

understand that this information will be used to

guarantee me status as a volunteer. I must meet all

determine my eligibility for a volunteer position with this

stated conditions required of the position for which I am

organization. I also understand that as long as I remain

asking to be considered.

a volunteer here, they may repeat this criminal history

check at any time.

I have read the above statements and accept the same

as a condition of my placement with the YMCA.

In the event I volunteer, I understand that all volunteers

are subject to dismissal at the discretion of the YMCA.

Signature: _____________________________________________ Date: ________________

Parent or guardian’s signature _____________________________ Date: _________________

(If you are under 18)

Application For Volunteer Service At The Palestine Ymca Form Page 4

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