Volunteer Registration

Name *
Name
Address *
Address
Primary Phone *
Primary Phone
Date of Birth *
Date of Birth
Emergency Contact Name *
Emergency Contact Name
Emergency Contact Phone *
Emergency Contact Phone
Have you ever been convicted of a crime (felony or misdemeanor) other than a minor traffic violation? *
Would you like to join our mailing list to receive our newsletter, event updates, and general DSACT communication? *
What volunteer activities interest you most? *
Please indicate the days you are usually available to volunteer. *
Please indicate the times you are usually available to volunteer. *
Please share anything you'd like us to know about you.
Skills and Experience *
In which areas do you feel you have moderate to excellent skill? Check all that apply.
Are you fluent in any of the following languages? *
Please select all that apply.
Volunteer Agreement *
I agree to serve as a volunteer and commit to the following: 1. To perform my volunteer duties to the best of my ability. 2. To respect those we serve. 3. To meet time and duty commitment, or to provide adequate notices so that alternate arrangements can be made. 4. To maintain open communication with my supervisor and volunteer coordinator regarding any issues or concerns. 5. To adhere to rules and procedures, including confidentiality of agency and client information. I understand and agree that submitting this application form does not automatically register me as a DSACT volunteer, and that there may be certain qualifications I must meet before I may begin volunteering, including but not limited to the acceptance of established volunteer policies and procedures, and successful completion of a background check. I give DSACT permission to take photographs and/or video of me, and I grant DSACT full rights to use such photographs and/or video of me, and any reproductions or adaptations thereof, for fundraising, publicity or other purposes, including but not limited to the right to use them in printed and online publicity, social media, and press releases. Furthermore, I agree to release, defend, hold harmless and indemnify DSACT from any and all claims involving the use of my picture or likeness. I recognize and acknowledge that there are certain risks of physical injury to volunteers providing and/or engaging in volunteer activities, and I voluntarily agree to assume the risk of all injuries, death, damages, or loss, regardless of severity, that I may sustain as a result of such volunteer activities. I furthermore agree to waive and relinquish all claims I may have as a result of such volunteer activities against DSACT, or any of DSACT’s respective officers, employees, agents, and/or other volunteers, collectively or individually. By submitting this form, I attest that the information I have provided on the form is true and accurate to the best of my knowledge.