Survey - Volunteer Application - Volunteers of America-Shreveport

Volunteer Information:


*	First Name: Required
*	Last Name: Required
*	Email: Required
*	Street 1: Required
	Street 2:
*	City: Required
*	State / Province: Required
*	ZIP / Postal Code: Required
*	Phone Number: Required
	Gender:
	Date of Birth:	Date of Birth:
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Question - Not Required - Race/Ethnicity:

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Question - Required - How would you like us to contact you?

Question - Not Required - What is your current occupation?

Question - Not Required - What is your educational background (high school, some college, degrees earned, etc.)?

Question - Not Required - What are your hobbies, skills or interests?

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Question - Required - Do you know how you would like to volunteer with us? For a list of volunteer opportunities, copy and paste this link into your browser: https://voanorthla.org/get-connected/#volunteer

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - Please check any of the populations with whom you are interested in working:
Please make up to 5 selections from the choices below.

	Children ages K-8th Grade
	Teens
	Seniors
	Veterans
	Adults with Disabilities

Question - Not Required - How often would you like to volunteer?

Question - Not Required - What times/days are you available to volunteer?
Please make up to 5 selections from the choices below.

	Weekdays
	Weekends
	Mornings
	Afternoons
	Evenings

Question - Not Required - If you have a disability, please list any accommodations you need to volunteer:

(Maximum response 255 chars, approx. 5 rows of text)

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Question - Required - Have you been convicted of a criminal offense?

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Question - Required - Liability Release: I wish to volunteer. I may perform in a capacity as a volunteer that may involve physical activity, contact with unidentified and/or unfamiliar persons, or other potential risk of bodily injury or damage to property. Knowing this and in consideration of being allowed to volunteer, I HEREBY ASSUME FULL AND COMPLETE RESPONSIBILITY FOR ANY PERSONAL INJURY AND/OR PROPERTY DAMAGE THAT I SUSTAIN OR CAUSED DURING MY PARTICIPATION AS A VOLUNTEER. IN ADDITION, I HEREBY RELEASE, HOLD HARMLESS AND CONVENANT NOT TO FILE SUIT AGAINST ANY GROUP AFFILIATED WITH THIS VOLUNTEER OPPORTUNITY.*

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Question - Required - Policies and Procedures: I have read and understand the volunteer policies and procedures that are listed online at www.voanorthla.org under the volunteer tab. I understand that failure to adhere to these policies may result in termination of my volunteer placement with Volunteers of America of North Louisiana*

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Question - Required - Mandatory reporting: I understand that under Children's Code Article 609(A) I will be considered a "mandatory reporter," and will be obligated to report any abuse, neglect, or sexual misconduct of any client, staff, or volunteer of Volunteers of America.* If you believe any of this activity has occurred, please report the activity to the program supervisor immediately and complete an incident report for required documentation.*

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Question - Required - Photo Release: As a volunteer I hereby give my consent for representatives of this event, news media and others affiliated, to photograph me while volunteering. I also give my permission for the use of said photographs in literature, websites and other promotional materials.*

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Question - Required - SchoolMessenger Release: As a volunteer, I give Volunteers of America North Louisiana my consent to contact me via SchoolMessenger, a Short Message Service (SMS) used to more effectively communicate via phone, text, and e-mail.*

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Question - Required - Volunteers of America North Louisiana (VOANLA) has put in place preventative measures to reduce the spread of COVID-19; however, VOANLA cannot guarantee that you and/or your child will not become infected with COVID-19. Further, participation in activities associated with VOANLA could increase your or your child's risk of contracting COVID-19. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to myself and/or to my child (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I may experience or incur in connection with my participation in volunteering with VOANLA.

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Question - Required - I verify that the above information is true. I understand that any false or misleading information is ground for denying or terminating my volunteer placement. I further understand that copies of this application will be sent to the Volunteers of America program in which I have indicated interest. The original will be retained in my volunteer personnel file. This understanding is certified by my signature below: