Fillable Volunteer Application - Ymca Of Greater Long Beach (Page 2 of 5) in pdf

Conditions of Volunteer Participation and Release from Liability

The YMCA of Greater Long Beach is an Association that welcomes people of all ages, ethnic groups, and

religious affiliations to unite in a common effort to put Judeo-Christian principles and values into practices,

through programs that develop healthy spirit, mind, and body for ourselves, our families, our children and

community.

Background Certification: I certify that all of the information provided on this application is true and

complete. I authorize the YMCA to investigate and verify any and all of the information I have submitted.

Because the YMCA’s priority of providing a safe environment for children and youth, I understand the YMCA may

order a criminal history check, and I authorize this investigation.

Volunteer Terms: I agree to abide by the YMCA of Greater Long Beach’s policies, procedures and Code of

Conduct. I understand the YMCA does not provide any health benefits (i.e. medical, dental, workers

compensation, etc.) or any accident insurance for me as a volunteer; I understand it is my responsibility to

provide this coverage. I understand that the YMCA of Greater Long Beach does not trade volunteer services for

membership or program fees.

Property Loss: I understand the YMCA is not responsible for my personal property lost, damaged or stolen

while participating in YMCA volunteer activities.

Medical Treatment: I give permission for YMCA representatives to provide emergency care for me, to arrange

for transport to an emergency center for treatment, and I consent to medical treatment deemed immediately

necessary or advisable by a physician if I am unable to act on my own behalf.

Photograph Permission: I give permission for the YMCA to use, without limitation or obligation, photographs

or other media that may include my image or voice to promote or interpret YMCA programs.

Release from Liability: I acknowledge the conditions of volunteer participation as stated above. If applicant

is under age 18, I give permission for my dependent to participate in YMCA volunteer activities. I understand

that accidents can sometimes happen. In exchange for the YMCA allowing me, or my dependent, to volunteer, I

hereby release the YMCA of Greater Long Beach, its agents, servants and employees from all liability and

ordinary negligence, including all claims for injury, illness, death, loss or damage, which may result from my, or

my dependent’s, participation as a volunteer.

_____________________________________________

___________________

Volunteer Applicant Signature

Date

_____________________________________________

___________________

Parent or Guardian, if Volunteer Applicant is under age 18

Date

For YMCA of Greater Long Beach Staff Use Only

Branch/Site:

Program Placement(s):

Program Director/Supervisor:

Approximate Start Date:

Mandatory:

Follow-up (dates):

___references (minimum 2)

Background forms to HR_________

___Safety/Child Abuse form

Data entry completed___________

___Checked Megan’s Law Website

Volunteer Application - Ymca Of Greater Long Beach Page 2

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