Volunteer Application and Agreement Form

*If volunteer is under 18 years, the parent or guardian must also complete a volunteer application and agreement form.
When are you available to work (specify hours of availability)
List Your Past Volunteer Experiences
BACKGROUND CHECK: DSAHV requires volunteers working with individual consumers to submit to a background check. Criminal conviction does not necessarily bar an applicant from volunteering. The nature of the offense will be taken into consideration before a decision is made. There is no fee on the part of the volunteer for the background check. Screening must be completed before volunteers begin working with consumers
REFERENCES: List two people, not related to you who have knowledge of your qualifications
As a volunteer for DSAHV, Org., I agree to abide by all applicable rules and regulations of the agency and the New York Division of Developmental Disabilities. I understand that I will receive no monetary benefits in return for my volunteer service and that DSAHV may terminate this agreement at any time without prior notice for any reason. I hereby authorize DSAHV to check my references, and I understand that a criminal background check is required. I certify that my answers on this application are true and complete and that I have not knowingly withheld any information that might, if disclosed, affect my application unfavorably. I understand that any misrepresentation or omission of facts on this application could be cause for rejection of this application or dismissal. I understand that after I submit my application, it will be reviewed and my eligibility for volunteer work will be determined. I agree to an interview with a member of the Board of Representatives prior to performing my volunteer role. I hereby Release and Waive liability against DSAHV, Org., a non-profit corporation, its directors, officers, employees and agents, its successors and assigns, for any injuries or illness that I myself or my dependent may suffer in connection with any volunteer work for DSAHV. Further, I agree that DSAHV, Org., is not liable for any damage to my property or my dependent’s property resulting from volunteer work for DSAHV. I agree that this release is as broad and inclusive as permitted by the laws of the State of New York.