Volunteer Application
Please take a moment to complete the form below prior to taking part in volunteer opportunities by Healthy Aging Association.
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First Name *
Last Name *
Street Address *
City *
Zip Code *
Home Phone Number
Cell Phone Number *
Email Address *
Birth Month *
Birth Day *
Emergency Contact Name *
Emergency Contact Phone Number *
Are you 18 years or older? *
Are you Bilingual? *
If Yes, what languages?
Do you have your own transportation? *
How many hours are you interested in volunteering for? *
Please check the day(s) of the week you are available. *
Required
Please indicate the time of day you are available. *
Required
Please select the areas you are interested in volunteering. *
Required
WAIVER: understand that this is an application for and not a commitment or promise of volunteer opportunity, nor am I obligated to accept a position offered.  CONSENT TO PHOTOGRAPH/RECORD I hereby authorize the Healthy Aging Association, and affiliated not-for-profit organizations to permit news media and other representatives to photograph or film me and agree they may use, or permit others to use, tapes, films, or prints, prepared there from. I agree that the above named organizations, their employees, and agents, shall not be responsible in any way for the content of news media coverage in which the photography authorized herein is used. HOLD HARMLESS AGREEMENT The undersigned shall hold the Healthy Aging Association, and affiliated not-for-profit organizations, their agents, officers, directors, employees, consultants, and their successors, and volunteers harmless from and save, defend and indemnify them against any and all claims, losses, liabilities and damages from every cause, including but not limited to injury to person or property or wrongful death, with the indemnity to include reasonable attorney’s fees, and all costs and expenses, arising directly or indirectly out of any act or omission of the undersigned, whether or not the act or omission arises from the sole negligence or other liability of aforementioned Agencies, or its agents, employees, or volunteers relating to or during the performance of its obligations under this agreement. I have carefully read this agreement and fully understand its contents. I am aware that this is a release of liability and a contract between myself and the Healthy Aging Association, and affiliated not-for-profit organizations and sign it of my own free will. Minor Volunteer Authorization: If you are under 18 years of age PLEASE CALL OUR OFFICE (209)525-4670 prior to signing.

Please type your full name to agree to the agreement above.
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