Volunteer Today!

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

Please choose the program/organization that best matches how you heard about us. *

SWIHA

College/University

UofA CHIP

Other

Are you currently employed? *

Yes

No

Are you looking for a consistent volunteer opportunity? *

Yes, weekly

Yes, monthly

No

Do you have required hours for an institution? *

Yes

No

SMS Opt-In

By checking the box, I give permission to be contacted about Amanda Hope Rainbow Angels by SMS text at my residential or cellular number, dialed manually or by autodialer (consent to be contacted is not a condition to participate). I consent to be contacted even if my phone number appears on an Amanda Hope Rainbow Angels Do Not Call List, a State or National Do Not Call Registry, or any other Do Not Contact List.

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.

COVID Waiver *

By checking this box, I agree to comply with the written instructions below. I, wishing to receive services from Amanda Hope Rainbow Angels or participate in Amanda Hope Rainbow Angels events/programming, hereby acknowledge that it is doing everything it can to protect the public as well myself and my family members in attendance. 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 wash or sanitize my hands after using the restroom, sneezing, coughing, and/or before handling food for distribution. Amanda Hope Rainbow Angels is not responsible for any potential exposure to Novel Coronavirus, or COVID-19, which is not a direct result of gross negligence on the part of its employees, volunteers, or the organization. Failure to comply with these written instructions or verbal instructions from staff may result in my family losing privileges to receive services and/or participate in events/programs 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.