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September 5, 2024
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Meal With A Mission Volunteer Application
Volunteer Information
Name
Address
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone
Email
Date of Birth
MM slash DD slash YYYY
Is the volunteer under the age of 18?
Yes
No
If so, please select yes to provide contact information for a parent/guardian that will be copied on all communications.
Name of Parent/Guardian
Email of Parent/Guardian
Phone of Parent/Guardian
Is the Parent/Guardian information also the Emergency Contact?
Yes
No
Emergency Contact Name
Emergency Contact Email
Emergency Contact Phone
Have you ever been convicted of, or plead guilty to any criminal defense?
Yes
No
Please describe in full detail below. Please note we do not accept volunteers who have been charged with offenses that reflect potential danger to the staff, offices, property of The Arc of Southwest Georgia, or the people who we support.
Volunteer Agreement
By submitting this volunteer application, you are agreeing to the following:
• I am allowing The Arc of Southwest Georgia to perform a background check or require my fingerprinting if I will be working with the individuals The Arc of SouthwestGeorgia supports.
• I am not an employee of The Arc of Southwest Georgia and understand and agree thatI will not receive compensation or benefit nor be eligible for any coverage under theGeorgia Worker’s Compensation Laws.
• I hereby affirm that I have accurately completed this volunteer application. My answers to all questions are true and correct, and I have not knowingly withheld any fact or circumstance that may, if disclosed, affect my application unfavorably. I understand that any false or incomplete information submitted in this application mayresult in my termination from The Arc of Southwest Georgia as a volunteer.
• I understand that as a volunteer, I will be required to perform assigned tasks at the dates and times specified and agreed upon with the assigned department director. I understand that by volunteering at The Arc of Southwest Georgia I will be required to follow policies and procedures and act in a manner that represents our mission.
• By volunteering for this event, I understand that I assume all risks associated with it, including but not limited to:
• Falls, physical contact with others (including the contraction of a communicable disease resulting from contact), effects of weather, traffic and road conditions.
• I, for myself and anyone entitled to act on my behalf, waive and release The Arc ofSouthwest Georgia, the cities and counties this event takes place, all event sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in this event, even though the liability may arise our of negligence or carelessness on the part of the persons named in the I waiver. In addition, I acknowledge the contagious nature of COVID-19 and other communicable disease and voluntarily assume the risk that I may be exposed to or infected may result in personal injury, illness, permanent disability, and/or death. I understand that the risk of becoming exposed to or infected by COVID-19 in connection with my participating in this event and personally assume this risk.
• I grant permission to all of the foregoing to use my photographs, motion pictures, recordings or any other recording of this event for any legitimate purposes. I understand that The Arc of Southwest Georgia cannot control what other people may do to an image or recording after it is shared. I recognize that any issues that arise out of the use of my photographs, motion pictures, or recordings will not be the fault of The Arc of Southwest Georgia.
• I also affirm that if I am under the age of 18 that my parents/guardians have reviewed my application and have agreed to the conditions of my participation.
Name of Volunteer
First
Last
Date
MM slash DD slash YYYY
Signature
Parent/Guardian Name
First
Last
Date
MM slash DD slash YYYY
Signature
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Home
About
Press Releases
September 5, 2024
Our Team
Board of Directors
Contact Us
Services
Apply for Services
For Children & Youth
Kids’ Corner Child Development Center
For Adults
Vocational Services
Independent Living Program
SOURCE
ICWP
Project ARC
Residential
For Families
Family Support Services
Get Involved
Become a Volunteer
For Businesses
Events
Resources
Join Our Team
Apply For Services
Donate
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