Full, Legal Name
*
First Name
Last Name
Date of Birth
*
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Email
*
Re-type Email
*
Phone
*
(###)
###
####
Group Name (if serving with a group)
Race
*
Black
White
American Indian/Alaskan Native
Asian/Pacific Islander
Hispanic
Other
Prefer not to answer
Gender
*
Male
Female
Prefer not to answer
Required Hours??
*
Are you looking for a place to get required service hours?
Have you been charged with or convicted of a felony within the past 5years? (We do background checks on each applicant.)
*
Have you ever been employed by JIS?
*
Are you a current or former client of JIS?
*
Have you ever been charged with child abuse, assault, or sexual offenses of any nature?
*
Emergency Contact Name
*
Emergency Contact Relation to You
*
Emergency Contact Phone Number
*
(###)
###
####
I am interested in the following volunteer opportunities:
*
Do you have other information/questions to share with our Volunteer Coordinator?
Are you currently a minor? If yes, then proceed. If no, then skip down to Volunteer approval and Signature.
*
No
Yes
ONLY APPLICABLE IF YOU ANSWERED YES: As the guardian of the above-named Volunteer, I give my permission for him/her to volunteer at the Interfaith Shelter. While minimal, I realize there are inherent risks associated with interacting with the homeless community. I assume full responsibility for personal injury and further release and discharge Jackson Interfaith Shelter for injury, loss or damage arising out of my child’s use of or presence upon the facilities of the Jackson Interfaith Shelter, whether caused by the fault of my child, the Jackson Interfaith Shelter or other third parties. I acknowledge that both I and my child have filled out a volunteer application and read all waiver material in the application. Further, we agree to observe and obey all posted rules and warnings, and further agree to follow any oral instructions or directions given by the Jackson Interfaith Shelter, or the employees, representatives, or agents of Jackson Interfaith Shelter.
As the parent/gaurdian, I agree to all of the above
Not applicable
I agree to the terms and conditions linked above this form. I understand that these policies are in place for the safety of the volunteers, guests, and staff of JIS. If I am in violation of them, I understand that I can be immediately dismissed from volunteer service for JIS. My typed signature is considered a legal, handwritten signature on this form submission.
*
