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1 [Please Print] Catholic Charities of Central Colorado Volunteer Registration and Waiver Name: Last First Middle Initial Address: Street City State Zip Gender: Male Female Phone: (H) (C) Date of Birth: (By providing an address, you consent to receive electronic communications from Catholic Charities) How did you hear about us? What affiliations (church/community groups) do you have? I. Skills and Interests to Offer Education Background: Languages (please indicate written/oral proficiency level): Current Occupation/Employer: Hobbies, Interests, and Skills: Previous Volunteer Experience: Have you had any volunteer or vocational experience working with children or students? Yes No If you are volunteering for a school /organization (non-court) that requires volunteer hours, what is the name? Note: If you are under 16 years of age, Marian House safety practices require that you do not handle a knife. Is there a particular type of volunteer work in which you are interested? (Check all that apply) Administrative Support Christmas Outreach Program English as a Second Language Teacher (FT or PT) English as a Second Language Tutor Fundraising for Catholic Charities Language Interpretation for Immigrant Families at Immigration Interviews Parenting/Education Facilitator Childcare Monitor During English as a Second Language Classes Computer Lab Assistant/Research Assistant English as a Second Language Teaching Assistant Food Pick Up/Delivery Driver Assistant Furniture Pick Up/Delivery (Castle Rock location) Marian House Soup Kitchen Mentor Reading to Young Children

2 Reception/Customer Service Research or Completing an Individual Project Skilled in Cooking for Large Groups (if yes, please detail experience on line below) Sorting/Cleaning Children s Books Sorting/Distributing Donations Speaker s Bureau Special Events. If yes, are you available evenings and/or weekends? Yes No Street Outreach Homeless Engagement And Response Team (HEART) Translation of Foreign-Language Documents Truck Driver (Castle Rock location) (no CDL required). Can you drive a manual transmission? Yes No Availability: AM Runs (7:00 am 11:55 am) PM Runs (12:00 5:00 pm) Note: Most available volunteer opportunities at the Colorado Springs location will be in the Marian House Soup Kitchen. Opportunities to volunteer in other departments are less frequent, but we would like to know if you are interested when a position is available. II. Availability At what times are you interested in volunteering? Weekdays Weekends Day Hours Evening Hours Flexible Times during the week when I cannot volunteer: Do you have access to an automobile you can use for volunteer work? No Yes Occasionally III. Personal History Do you have any physical conditions or disabilities that may limit your ability to perform tasks? Yes No If yes, please explain: [Optional] If for any reason we need to call EMS for you, are there any medical conditions or medications you would like us to tell them about? Emergency Contact: Phone: Has anyone ever brought or threatened to bring a civil or criminal claim against you alleging physical or sexual abuse or sexual harassment by you? Yes No If yes, please explain. (Include date, nature, and place of incident; where complaint was filed, and disposition of complaint) Have you ever been convicted of a felony? Yes No If yes, please explain: (Indicate date, nature, and place of the incident; the disposition of the allegations; and your employer at the time, including your employer s name, address and telephone number)

3 Dress Code At All Locations: All clothing must be clean and in good repair. No suggestive pictures or sexually-provocative clothing may be worn. Corporate logos are permitted if the apparel is otherwise in compliance with the requirements of this paragraph. No tank tops, shorts, capris, or cut-off pants. Additional Requirements at the Marian House: Shoes must be closed-toed, closed-heeled, and slip-resistant. Skirts will be permitted if religious practice dictates; however, job duties may be modified to accommodate compliance with existing health codes and Marian House safety practices. The wearing of jewelry is discouraged. If you wear a watch, it must be covered by a glove (provided by Marian House) or removed. No headphones or cell phone use while working. If hair is below the chin or touches the shoulder, it must be tied back. If you have an open wound, management must be notified upon your arrival. If you fail to comply, you must leave. Harassment Harassment is prohibited and includes: Abusive language, derogatory statements, gossip and disrespectful comments, slurs, and innuendos; Assault, battery, bullying, unwanted touching, rude gestures, and sexual advances; Inappropriate posters, drawings, electronic images, text messages, s, and social media postings. Every volunteer who witnesses or is a victim of harassment should immediately report the matter to management. All complaints of harassment will be investigated. Volunteers must cooperate with any investigation. Volunteers must comply with The Bishops Charter for the Protection of Children and Young People and all provisions of the Diocese Sexual Misconduct Policy attached as Appendix A. Some people have medical conditions where touch is painful; also, some of our clients may have life experiences that make unsolicited touch distressful. For your safety and the safety of the people we serve and volunteer with, please request a client s permission before providing supportive physical contact of any kind to assist a person who appears to need it. You can offer or accept a handshake at your own discretion. Both physical contact with a client who has expressed a reservation, or inappropriate physical contact of any kind regardless of client consent, are unacceptable. Proselytizing This can be defined as efforts to induce someone to convert to one's faith or to recruit someone to join one s party, institution, or cause. Volunteers for Catholic Charities are prohibited from proselytizing in any capacity. Our services are not contingent on individuals participating in our faith or any faith. However, this does not prohibit productive or helpful spiritual discussion, especially when invited to do so by the people you meet. Do not argue with people about the faith. Rather, find a compassionate way to share the truth. Volunteer Waiver and Release of Claim Catholic Charities of Central Colorado screens to provide a safe environment for children participating in our programs and/or on our premises. A signed release will be required for all volunteers directly interacting with children. This release will provide Catholic Charities the authority to conduct a background check and talk to past supervisors where applicant worked/volunteered with children s organizations and programs. Abuse of children is taken very seriously, and all outcries or reports of abuse are reported to police or Child Protective Services (CPS), and we fully comply with requests from authorities investigating child abuse. Catholic Charities has adopted policies/procedures specifically created to safeguard children in its programs. Contact/interaction with children in all program contexts will be randomly monitored. The undersigned acknowledges and understands that accidents resulting in injury occasionally occur during such activities as the undersigned will be engaging in. Notwithstanding the foregoing, the undersigned hereby agrees to fully assume any and all risk of harm or injury which may occur to the undersigned during any activity, and to release and hold harmless Catholic Charities and its officers, agents, employees, and other volunteers from any claims or causes of action as set forth above. Finally, it is understood and agreed that this waiver, release, and assumption of risk is binding on the heirs, successors, and assigns of the undersigned. Name: Print Date: Signature [Continue to page 4 to complete AARSMP]

4 Acknowledgment and Affirmation of Receipt of Sexual Misconduct Policy I,, acknowledge that I have received and reviewed the (Please print your name) Sexual Misconduct Policy of the Diocese of Colorado Springs Tenth Revision Effective March 31, I understand that if I have any questions regarding my duties under this policy, I am invited to consult with the Diocesan Human Resources Administrator. I affirm that I will comply with all obligations described by this policy and any subsequent revisions of this policy. Signature: Date: Office Use Only Date Interviewed Time Interviewed Staff Initials Approved Yes No Start Date Comments:

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