Volunteer Agreement Form

Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Date of Birth *

MM

DD

YYYY

May we contact you by mail or email regarding upcoming needs and events? *

Yes

No

Confidentiality Agreement *

As a condition of volunteering or participating in a project, I understand and agree to the following:

All information which I receive in connection with my contract with the Clubhouse or its Members will be held in the strictest confidence.

I understand that disclosure of any of the confidential information may be subject me to penalties which may be imposed by the State or Federal Law and may subject me personally to Civil Liability.

Date

MM

DD

YYYY

Volunteer Agreement *

I understand and agree to the following:

All information which I receive in connection with my contract with the Clubhouse or its Members will be held in the strictest confidence.

I understand that disclosure of any of the confidential information may be subject me to penalties which may be imposed by the State or Federal Law and may subject me personally to Civil Liability.

Date *

MM

DD

YYYY

Background Checks *

I understand and agree to the following:

As the Clubhouse serves individuals of a vulnerable population and at times, minors, I understand that a brief background check that includes a screening for any sexual offenses will be completed to ensure the safety of all, our members, staff and volunteers.

Date *

MM

DD

YYYY