Apply to Volunteer in Nevada

Name *

First Name

Last Name

Birthdate

MM

DD

YYYY

Cell Phone *

(###)

###

####

Home Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact Name *

First Name

Last Name

Emergency Contact Phone *

(###)

###

####

Do you give us permission to transport you to the nearest medical facility should you incur serious illness or injury during volunteer hours? *

Yes

No

Are you currently employed? *

Yes

No

Availability

Days

Nights

Weekdays

Weekends

Are you restricted as to availability to attend volunteer events? *

Yes

No

Do you have required hours for an institution? *

Yes

No

Media Consent

By checking this box, I hereby give my permission for Amanda Hope Rainbow Angels and/or its representatives to use artwork, photographs and/or letters that I provide of myself in publications, slides, videotapes, motion pictures or on the Internet. In addition, I hereby give my permission for Amanda Hope Rainbow Angels and/or its representatives to photograph, audio tape record, or videotape myself and to use my name, these images or voice recordings in publications, slides, videotapes, motion pictures or on the internet. I understand these visual images or voice recordings may be used to inform families, volunteers, donors, the media and general public about Amanda Hope Rainbow Angels programs, services or events. I gladly give this authorization to support the efforts of Amanda Hope Rainbow Angels. I understand this authorization shall continue until terminated in writing. Providing consent form is not a requirement in order to join the Amanda Hope Rainbow Angels volunteer program.

SMS and Email Opt-In

By checking this box, I agree by signature to be contacted about Amanda Hope Rainbow Angels by SMS text at my residential or cellular number or provided email address, dialed manually or by autodialer and to be contacted via email. I consent to be contacted even if my phone number or email address appears on an Amanda Hope Rainbow Angels Do Not Call / Do Not Email List, a State or National Do Not Call Registry, or any other Do Not Contact List. Opting in is not a requirement in order to join the Amanda Hope Rainbow Angels volunteer program.

COVID Waiver *

By checking this box, I wishing to volunteer my time and services for Amanda Hope Rainbow Angels, hereby acknowledge that they are doing everything they can to protect the public as well myself as a volunteer. To this extent, I agree to follow Center of Disease Control (CDC) and local health district guidelines and Amanda Hope Rainbow Angels policies and procedures for social distancing to reduce the spread of Novel Coronavirus, or COVID-19. I agree to utilize surgical masks or improvised masks such as scarves, bandanas, and handkerchiefs to reduce the risk of exposure to myself and others when requested. I agree to wash or sanitize my hands after using the restroom, sneezing, and coughing, and before eating or preparing meals or sundries for distribution, and will properly wear and utilize sterile gloves. I understand that I may be informed of or encounter sensitive Personal Health Information (PHI) for those that Amanda Hope Rainbow Angels serves. I agree to hold this information in confidence and will not disseminate any PHI except as allowed by law and/or per the policy and procedures of said organization which I am volunteering for. I understand that there is no direct medical health coverage afforded to me during my relationship with Amanda Hope. Amanda Hope Rainbow Angels is not responsible for any potential exposure to Novel Coronavirus, or COVID-19, which is not a direct result of negligence on the part of their employees, volunteers, or the organization. By checking the box, I agree to comply with the written instructions above. Failure to comply with these written instructions or verbal instructions from staff may result in my volunteer privileges being removed and I may be asked to leave the premises.

Volunteer Certification *

Amanda Hope Rainbow Angels is dedicated to a policy of non-discrimination on any basis including race, color, religion, sex, national origin, sexual orientation, age, disability, status as a Vietnam-era or special disabled veteran, or any other legally protected status. Consistent with the Americans with Disabilities Act, applicants may request accommodations needed to participate in the application process. Participation in some aspects of the Amanda Hope Rainbow Angels Volunteer Program may be contingent upon the successful completion of specific Hospital Training Programs, screening requirements as determined by participating hospitals, and the continued adherence to the policies of the Amanda Hope Rainbow Angels Volunteer Program as outlined in the Manual of Procedures. Submission of this application does not guarantee admission into the program.

By checking this box, I certify that all information submitted by me on this application is true and complete. I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected and active status may be terminated at any time. In consideration of my Volunteer Program application, I agree to adhere to the policies and regulations of Amanda Hope Rainbow Angels, and I agree that my volunteer status can be terminated, with or without cause, and with or without notice, at any time by Amanda Hope Rainbow Angels.