Volunteer

Full Name *

Street Address Line 1 *

Street Address Line 2

City, State, Zip Code *

Email *

Phone *

Volunteer Experience *

Special skills, training, interests and hobbies you could offer us *

What kind of volunteer work most interests you? *

What are the days and times that work best for you to volunteer? *

What languages do you speak? *

Emergency Contact Info

Emergency Contact Name *

Emergency Contact Relation to You *

Emergency Contact Phone *

References

Please give us the names of two persons, not related to you, whom you have known for at least one year.

Reference #1

Name *

Contact Phone *

How do you know this person & how long have you known them? *

Reference #2

Name *

Contact Phone *

How do you know this person & how long have you known them? *

I Authorize Diverse Daisies to contact my two references listed above *
I accept

(Please advise your two references above that they can expect to be contacted regarding this application)

Agreement

In consideration of being accepted as a volunteer for Diverse Daisies and with knowledge that I will be working, directly and indirectly, in a volunteer capacity for Diverse Daisies Involving various duties, I recognize fully that my presence and activity as a volunteer may involve some element of risk.

I, the undersigned, do hereby waive and release any and all rights or claims of any kind or nature of myself, and those of my heirs or assigns, which may exist or accrue in the future against Diverse Daisies, its various departments, personnel, employees, officials staff, or agents because of, as a result of, or in connection with the duties, responsibilities, and work which I will undertake as a volunteer for Diverse Daisies.

I understand that as a volunteer I am in no sense an employee of Diverse Daisies, and that I possess no rights under Diverse Daisies. Further, I understand that I am not entitled to benefits or worker’s compensation benefits from Diverse Daisies, which may accrue to it employees. I further understand that I am not entitled to any vested rights to which an employee of Diverse Daisies may be entitled.

I acknowledge and understand that I am only to perform such functions as specifically directed by Diverse Daisies.

I hereby authorize Diverse Daisies to contact the references listed on my volunteer application in order to determine my eligibility for volunteer services and authorize Diverse Daisies to make such other inquires as may be necessary to determine my eligibility for such services.

Volunteer Waiver Confirmation *
Yes, by me checking this box I acknowledge that I have read and understand the above waiver.

Parent Confirmation (for Minors Under 18)
Yes, by me checking this box I acknowledge that I have read and understand the above waiver.

Volunteer Printed Name *

Parent Printed Name (for Minors Under 18)