Adult Volunteer Application
Giving Gardens of Indiana
479 S. Towerview Drive
Columbia City, IN 46725
260-609-6784
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Screening
For the safety of students, all prospective volunteers will be asked to fill out the Adult Volunteer Application. All prospective volunteers will be given a "background check" pursuant to state public record. Additionally, Giving Gardens of Indiana in its discretion and without a statement of reason, may run a complete criminal history check on any volunteer at any time.
OFFICIAL USE ONLY / YOUR INFORMATION WILL BE KEPT CONFIDENTIAL
Each question below is required for the Department of Child Services to run a background check. Reminder, you must always disclose criminal information.
Date of Birth *
MM
/
DD
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YYYY
Legal First Name *
Legal Middle Name or Initial *
Legal Last Name *
Phone Number *
Program you would like to volunteer at: *
Have you been arrested, convicted, pled guilty, or pled nolo contendere to:
A criminal offense, other than a minor traffic violation, this includes but is not limited to a felony, gross misdemeanor, DUI, etc.? *
A drug or sexual related offense or act of violence? *
Reported for child abuse / sexual activities involving a student or minor or had charges filed against you by a school district, state/county agency, police or court? *
If YES to any of these answers, please explain the type(s) of offense(s), Locations and Dates in the space below.
Note: Any applicant on an active "Wants and warrants list, Registered Sex Offender, Terrorist list, or on Parole or Probation WILL NOT BE ALLOWED AT GIVING GARDENS OF INDIANA
Are you a parent/guardian/caretaker of a child enrolled in our program? *
If you do not have a child enrolled in our program, are you volunteering as part of a community organization or business member? If so, please list the name/s: *
Please list any allergies you may have. If none, type none. *
Please list an emergency contact person and phone number *
VOLUNTEER COMMITTMENT AND PROCEDURES
Please read carefully before signing and dating this application
Confidentiality
What you hear and observe about students, families and staff while volunteering at Giving Gardens is confidential. Repeating a seemingly harmless comment can lead to misunderstandings and hurt feelings. For our organization to provide the best environment for learning, everyone's privacy must be respected.
Child Abuse and Neglect Reporting
Volunteers are obligated under mandatory child reporting laws to report any suspected child abuse or neglect. Please speak with a director to proceed on this reporting.
Supervision
Volunteers perform under the direction and supervision of Giving Gardens personnel. Volunteers should know and follow organization policies and rules. The organization, in its discretion and without a statement of reason, may suspend a volunteer from any further volunteer activities pending any background check.
Communication
If for any reason you are not able to volunteer when expected, please contact a director and leave a message. Similarly, Giving Gardens staff will contact you if your scheduled volunteer time is canceled or changed for any unforeseen reason. You may contact Rachel: 260-609-6784 or Jessica: 260-797-2040 or email givinggardensin@gmail.com with questions or for assistance.
Student / Volunteer Relationships
Volunteers function in a position of trust and Giving Gardens does not extend that position of trust outside of its supervised programs. It is the responsibility of the volunteer to notify the site administrator immediately if he/she becomes involved with a student/family outside of the Giving Gardens environment.
Waiver and Release
1. I, the Volunteer, release and forever discharge and hold harmless Giving Gardens of Indiana and its successors and assigns from any and all liability, claims, and demands of whatever kind of nature, either in law or in equity, which arise or may hereafter arise from the services I provide to Giving Gardens. I understand and acknowledge that this Release discharges Giving Gardens from any liability or claim that I may have against Giving Gardens with respect from the services I provide to Giving Gardens or occurring while I am providing volunteer services.
2. Insurance: Further I understand that Giving Gardens does not assume any responsibility for or obligation to provide me with financial or other assistance, including but not limited to medical, health or disability benefits or insurance of any nature in the event of my injury, illness, death or damage to my property. I expressly waive any such claim for compensation or liability on the part of Giving Gardens beyond what may be offered freely by Giving gardens in the event of such injury or medical expenses incurred by me.
3. Medical Treatment: I hereby Release and forever discharge Giving Gardens from any claim whatsoever which arises or may hereafter arise on account of any first-aid treatment or other medical services rendered in connection with an emergency during my tenure as a volunteer with Giving Gardens.
4. I understand that the services I provide to Giving Gardens may include activities that may be hazardous to me including, but not limited to bee stings, heavy lifting, heat exhaustion, involving inherently dangerous activities. As a volunteer, I hereby expressly assume rock of injury or harm from these activities and Release Giving gardens from all liability for injury, illness, death or property damage resulting from services I provide as a volunteer or occurring while I am providing volunteer services.
5. Photographic Release: I grant and convey to Giving gardens all right, title, and interests in any and all photographs, images, video, or audio recordings of me or my likeness or voice made by Giving Gardens in connection with my providing volunteer services to Giving Gardens.
6. Other: As a volunteer, I expressly agree that this Release is intended to be as broad and inclusive as permitted by the laws of the State of Indiana and that this Release shall be governed by and interpreted in accordance with the laws of the State of Indiana. I agree that in the event that any clause of provision of this Release is deemed invalid, the enforceability of the remaining provisions of the Release shall not be affected.
I AFFIRM THAT I HAVE READ AND UNDERSTAND ALL OF THE ABOVE INFORMATION ON THIS ADULT VOLUNTEER APPLICATION FORM AND THAT ALL OF THE INFORMATION I HAVE PROVIDED IN THIS APPLICATION IS TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE. I UNDERSTAND THAT GIVING GARDENS OF INDIANA RESERVES THE RIGHT TO VERIFY ALL THE INFORMATION ON THIS APPLICATION FORM AND THAT ANY FALSE STATEMENTS OR FAILURES TO DISCLOSE INFORMATION MAY BE SUFFICIENT TO DISQUALIFY ME AS A VOLUNTEER. I HEREBY AUTHORIZE GIVING GARDENS OF INDIANA TO OBTAIN INFORMATION ON MY CURRENT AND/OR PAST HISTORY OF CRIMINAL ACTIVITY.
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