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Volunteer Application

(Yellow Box indicates a required field)

First Name: Middle Initial:
Last Name:           
Address 1:
Address 2:

City :    State:

Zip Code:           Country   

                     Please use following format when entering phone numbers XXX-XXX-XXXX
Home Phone:                    Day Time Phone:

 

E-Mail Address:    

DOB:        Month    Day    Year  

Gender:                                        Drivers License #

Bilingual?   
Languages:

Employer:   

Profession: 

List any certificates or licenses you hold:

Church or civic memberships:

 

Skills and Talents:  
List your skills &talents:
 

Select the opportunities that interest you (you may select multiple options):

Back to School Food Drives Medical/dental Clinic
Resale by CCA Computer/Data Entry Family Assistance
Bread Pick up Donation Center GED Prep Classes
Christmas Toy Store New Hope Learning Center Giving Tree
Holiday Food Baskets Housing Jobs & Careers
Kids Eat Free Mentoring Office/Clerical
Pantry Pennies from Heaven Special Events
Senior Monday Transporting/Visiting People Work at Home
Why are you interested in volunteering at CCA?:
Has your family received assistance from CCA?:           
Please estimate your available hours per           week   or          month or   year
Days available: Mon Tues Wed Thur Fri Sat Sun
Hours available:   Morning   Afternoon   Evening  
Legal Stuff:
Contact:
 
Relationship:          
Home Phone:                                 Business Phone:           
May CCA use your picture in publicity material?          

Verify that the above information is complete and accurate.

  1. Will hold all information regarding CCA clients with utmost confidentiality.
  2. Will at all times behave in a decent and moral manner.
  3. Will exercise good judgment in regard to my health and safety while participating in CCA volunteer activities.
  4. I understand that reasonable measures will be taken to safeguard the health and safety of volunteer participants.
  5. Indemnify and hold harmless Christian Community Action, its employees and agents from any and all liability in connection with any injury or damage I may incur in these activities.
  6. I assume responsibility for my own safety.
  7. Acknowledge and expressly agree that by continuing to volunteer for CCA that any claim or dispute arising out of any accident or occurrence will be resolved exclusively through alternative dispute resolution procedures, including final and binding arbitration.
  8. The arbitrator shall issue a written decision and award, if any, stating the reasons thereof.
  9. The decision and any award shall be final and binding.
  10. No contractual relationship is hereby created other than this agreement to arbitrate.

I have read the above 10 items  and agree.                     If you do not accept the terms by selecting "yes", CCA can not accept your volunteer application.

Please do not submit this form, if you do not accept the terms.

             

 
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