Volunteer Application Form - Ymca Of South Palm Beach County (Page 2 of 2) in pdf

For the safety of our participants, staff and volunteers, we complete at least 2 reference checks on every program volunteer. References

may include supervisors, co-workers, faith leaders, teachers or school counselors. Please do not list relatives/ household members.

Name:

Phone number:

Relationship to you:

Email:

Name:

Phone number:

Relationship to you:

Email:

Name:

Phone Number:

Relationship to you:

Email:

Our Mission: To put Christian principles into practice through programs that build healthy spirit, mind and body for all.

Conditions of Volunteer Participation and Release from Liability

The YMCA of South Palm Beach County’s desire is to build a community where individuals, especially the young, are

encouraged to develop their full potential in spirit, mind and body. As a volunteer, I will cooperate in the

fulfillment of this mission.

Background Certification: I certify that all of the information provided on this application is true and complete. I

authorize the YMCA of South Palm Beach County (“YMCA”) to investigate and verify any and all of the information I

have submitted. Because the YMCA strives to provide a safe environment for children and youth, I understand that

the YMCA may order a criminal history check, and I authorize this investigation.

Volunteer Terms: I agree to abide by the YMCA’s policies, procedures and Code of Conduct. I understand the

YMCA does not provide any health benefits (i.e. medical, dental, workers compensation, etc.) or any accident

insurance for me as a volunteer; I understand it is my responsibility to provide this coverage. I understand that

the YMCA of South Palm Beach County does not provide volunteer compensation or trade volunteer services for

membership or program fees.

Property Loss: I understand the YMCA is not responsible for my personal property lost, damaged or stolen while

participating in YMCA volunteer activities.

Medical Treatment: I give permission for YMCA representatives to provide or arrange for emergency care for me,

and to arrange for transport to an emergency center for treatment. I consent to medical treatment deemed

immediately necessary or advisable by a physician if I am unable to act on my own behalf. I further understand

that the YMCA is not responsible for payment for such medical treatment.

Photograph Permission: I give permission for the YMCA to use, without limitation or obligation, photographs or

other media that may include my image or voice to promote or interpret YMCA programs.

Release from Liability: I understand that accidents may occur during my volunteer activities. By signing below, I

release the YMCA, its agents, directors, consultants, and employees from all liability based on any damage, loss or

injury, whether it is the result of ordinary negligence or otherwise, caused to me or my dependent from

participation as a volunteer.

_____________________________________________

_______________

Volunteer Applicant Signature

Date

I also give permission for my dependent to participate in YMCA volunteer activities.

_________________________________________

________________

Parent or Guardian, if Applicant is under age 18

Date

Volunteer Application Form - Ymca Of South Palm Beach County Page 2

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