Your information
Required fields are marked with an asterisk (*)
4 fields below are a file upload/attachment, the size of all uploaded files must be less than 10MB.
Today's Date *
A valid date as MM/DD/YYYY (for example: 11/30/2015)
First Name *
Middle Initial
Last Name *
Current Street Address *
Apartment/Unit #
City *
State *
Zip Code *
Cell Phone #
Home Phone #
Date of Birth *
A valid date as MM/DD/YYYY (for example: 11/30/2015)
Name of Emergency Contact *
Emergency Contact Phone # *
How did you hear about Goodman JFS Volunteer Services?
Employment History: What is/was your profession?
Are you currently employed?
If yes employed, for whom?
Do you hold any special license(s)/degres(s) that may be relevant to a specific program? If so, please list below:
Do you speak any languages other than English? If yes, which one(s)
Volunteer Experience: (List most recent service positions, agency & dates, if any)
Driver's License (Please upload a copy, must be valid)
The total size of any/all file uploads must be less than 10MB
Car Insurance Card (Please upload a copy, must be valid)
The total size of any/all file uploads must be less than 10MB
Parent or Guardian Name (If volunteer is under 18 years of age)
Parent or Guardian Address (If volunteer is under 18 years of age)
Parent or Guardian Phone Number (If volunteer is under 18 years of age)
Parent or Guardian relationship with underage volunteer
Volunteer Placement Preferences: *
If volunteering for DBJG Cupboard, Gift Card Delivery, Friendly Visitor or Jet Express program(s), to what cities in Broward County are you willing to drive?
Volunteer Group Leader *
Availability to Volunteer (please write availability during 9am to 6pm, mornings or afternoons, etc.) Days/Times *
Have you ever been convicted (found guilty) of a crime (including probation(s) before judgment), or are there any pending criminal charges awaiting a hearing in a court of law? Do not list any criminal charges for which records have been expunged. *
If yes, please explain: (Make sure to include the city/county/state and the year the crime occurred for each conviction.)
**Please note that for ALL volunteer positions, a criminal background check, FBI Level 2 will be conducted to ascertain if any criminal records exist which might hinder your ability to serve as a volunteer. This will be conducted by our current background
Notes Attachments
The total size of any/all file uploads must be less than 10MB
Would you like to receive our Newsletter? *
Disclaimer
AGENCY/VOLUNTEER AGREEMENT
GJFS of Broward's most valuable asset is its people - employees, volunteers, consultants, and members of our Board of Directors and those who participate in Board committees. The contributions made by all of our volunteers are an essential extension of our workforce. GJFS of Broward is committed to ensuring the volunteers are supported, valued and respected and has procedures in place to promote high standards and excellent customer service to our volunteers.
I agree to serve as a volunteer and commit to the following:
1. To perform my volunteer duties to the best of my ability.
2. To adhere to agency rules and procedures, including record-keeping requirements
and confidentiality of agency and client information.
3. To meet time commitments, or to provide adequate notice so that alternative
arrangements can be made.
4. To attend all volunteer program training meetings as required by the agency.
5. To report any client concerns to the Program Directors.
OATH OF CONFIDENTIALITY
The relationship between Goodman Jewish Family Services (GJFS), clients, donors, staff
and volunteers has a built in component of confidentiality. GJFS has a commitment to
protecting that confidentiality. All volunteers are expected to observe the principle of
confidentiality in obtaining and releasing information about clients. Information about a
client that is made known to a volunteer is to be used only for the purpose of giving service.
By signing below I understand and agree to the following:
- I acknowledge that I have received, read and understand GJFS of Broward's Privacy Policies and practices and agree to comply with these policies and practices.
- All confidential and/or personal health information that I have access to or learn through my affiliation with GJFS of Broward is confidential.
- Under no circumstances, except when required by law, may confidential and /or personal health information be communicated whether within or outside of GJFS of Broward except to other persons who are authorized by GJFS of Broward to receive such information.
- I agree to keep any computer access codes, passwords, confidential and secure.
- I will not lend my access codes or devices to anyone.
I understand that a breach of this oath of confidentiality may result in termination of my volunteer service at GJFS.
PLEASE READ CAREFULLY. THIS IS A LEGAL DOCUMENT WHICH AFFECTS YOUR LEGAL RIGHTS.
VOLUNTEER RELEASE AND WAIVER OF LIABILITY
I, the undersigned (collectively with my successors and assigns, heirs, legal representatives and executors, the "Volunteer"), do hereby execute this VOLUNTEER RELEASE AND WAIVER OF LIABILITY (this "Release and Waiver") in favor of Goodman Jewish Family Services, its successors and assigns, directors, officers, employees and staff (collectively referred to herein as "JFS") for participation in JFS Volunteer Programs (the "Program").
Volunteer desires to participate in the Program and other activities of JFS. In consideration for allowing Volunteer to participate in the Program and other JFS activities, Volunteer does hereby freely execute this Release and Waiver under the following conditions:
Assumption of Risk. Volunteer understands that his or her participation in the Program may include activities which may be hazardous to Volunteer or to Volunteer's property. Volunteer further acknowledges that there are inherent risks in participating in the Program activities, including, but not limited to, physical injury, property damage and death.
Volunteer hereby expressly assumes the risk of injury or harm in these activities and releases JFS and any other participant in the JFS's Programs ("Program Participants") from any and all liability for any claim or demand arising out of, related to, or resulting from Volunteer's participation in the Program, except to the extent that such claim or demand arises out of the negligence or willful misconduct of JFS or any Program Participant.
Release and Waiver. Volunteer hereby releases, waives and discharges any and all liability, claims, demands or rights of action, in law or equity, known or unknown, of whatever kind or nature against Program Participants and JFS arising out of, related to, or resulting from Volunteer's participation in the Program, except to the extent that such liability, claim, demand or right of action arises out of the negligence or willful misconduct of JFS or any Program Participant.
Indemnify and Hold Harmless. Volunteer hereby agrees to indemnify, defend and hold harmless JFS from any and all losses, claims, liabilities or expenses of whatever kind, arising out of, related to, or resulting from Volunteer's participation in the Program, except to the extent that such losses, claims, liabilities or expenses arise out of the negligence or willful misconduct of JFS.
Legal Status of Parties. Volunteer is not an employee or agent of JFS or the Program and Volunteer understands that he/she has no authority to act on behalf of or bind JFS. Volunteer also understands that JFS does not assume any responsibility for providing any assistance to Volunteer, including, but not limited to, medical, health, disability, automobile, or workman's compensation insurance.
Medical Treatment. Volunteer releases JFS and Program Participants from any claim whatsoever which arises or may hereafter arise as a result of any first aid, treatment, or service rendered in connection with Volunteer's participation in the Program, except to the extent such claim arises from the negligence or willful misconduct of JFS or Program Participants.
Volunteer Certifications. Volunteer certifies that he or she is physically and mentally competent to carry out the Program activities.
Photographic Release. Volunteer does hereby grant onto JFS and the Program all right, title, and interest in any and all photographic images, television spots, video or audio recordings, and/or stories, or any part hereof, JFS has taken or made of Volunteer in which the volunteer may be included in whole or in part during the Volunteer's activities with JFS, including, but not limited to, any royalties, proceeds, or other benefits derived from such photographs or recordings and consents to the unrestricted use by JFS of said images and recordings.
Complete Agreement. This Release and Waiver and, if applicable, any addendum executed concurrently with it, set forth the entire agreement between the parties with respect to the subject matter contained herein and it expressly supersedes all previous written and oral communications between the parties. If any provision of this Release and Waiver is found to be unenforceable, the remaining terms shall remain enforceable. With the exception of oral directives by Volunteer to JFS for the purpose of checking additional program boxes or adding additional programs to the signature pages, no amendment, alteration, or modification of this Release and Waiver shall be valid unless executed in writing by both parties to this Release and Waiver.
Binding Effect. This Release and Waiver shall remain in full effect and force and bind the successors and assigns, heirs, legal representatives and executors of the Volunteer.
Other. Volunteer hereby expressly agrees that this Release and Waiver is permitted and governed exclusively by the laws of the State of Florida, irrespective of choice of law principles. In the event any clause or provision of this Release and Waiver is ruled invalid, the invalidity of such clause or provision shall not affect the remaining provisions of this Release and Waiver which shall continue to be enforceable. This Release and Waiver may be executed in multiple counterparts, each of which shall be deemed an original, but all of which taken together shall constitute one and the same agreement. The electronic or facsimile transmission of an originally executed Release and Waiver signature page shall constitute an originally executed Release and Waiver.
Remainder of Page Left Intentionally Blank. Signature Page(s) Follow.
IN WITNESS WHEREOF, I, the undersigned, have carefully read this Release and Waiver of Liability and fully understand its contents. I am aware that this is a release and waiver of liability in favor of JFS and the Program Participants. I am aware that in the event I suffer loss or injury the terms of this Release and Waiver shall apply. Further, I am aware that I have given up substantial rights by voluntarily signing this Release and Waiver.
STANDARD RELEASE FORM
Consent to Use Photograph, and/or Images, Client History or Electronic Recording
This authorization affects your rights in the privacy of your personal information. Please read it carefully before signing.
Goodman Jewish Family Services, ("GJFS") will not condition provision or eligibility for services or benefits, as applicable, on your providing authorization for the requested use or disclosure.
YOU MAY REFUSE TO SIGN THIS AUTHORIZATION
I, the undersigned, hereby consent to the filming/taping/photographing of my image, and/or the recording of my voice, and/or the use of my name and/or likeness or image by GJFS. I also consent to the use, in any lawful manner whatsoever, by GJFS, or its licensees or assignees, of said filming/taping/photographing and/or recording of my voice and/or use of my name, likeness or image, provided that such use shall be solely for the purpose of publicizing and promoting GJFS. I also understand that once my image is distributed or posted on the GJFS website and or social media networks including and not limited to Facebook, Twitter, YouTube, Instagram and LinkedIn and other social media networks that image may be downloaded by any computer user, and that GJFS has no control over the subsequent redistribution or use of such image. I also agree to the sharing of my family history/story for public relations purposes including GJFS newsletters, annual reports, websites, Facebook, Twitter, YouTube, Instagram and Linkedin.
I understand I have the right to revoke this authorization, in writing, at any time, except to the extent that GJFS has taken action in reliance on it. A revocation is effective upon receipt by GJFS of a written request to revoke and a copy of the executed authorization form to be revoked at the address listed above.
This authorization shall expire upon the earlier occurrence of: (a) revocation of the authorization, (b) complete satisfaction of the purposes for which this authorization was originally obtained, to be determined in the reasonable discretion of GJFS, or (c) two (2) years from the date this authorization was executed. Note: Revocation or Expiration of this Authorization does not mean that existing content will be removed or deleted, only that no new or additional content will be used without your permission.
By signing this authorization I acknowledge and agree that any information used or disclosed pursuant to this authorization could be at risk for re-disclosure by the recipient.
I hereby release and discharge GJFS, its officers, directors, employees and agents for and from any and all liabilities and causes of action in connection with the above-mentioned use, and I hold GJFS and its officers, directors, employees and agents harmless from any and all liability in connection with such use.
AGENCY/VOLUNTEER AGREEMENT
GJFS of Broward's most valuable asset is its people - employees, volunteers, consultants, and members of our Board of Directors and those who participate in Board committees. The contributions made by all of our volunteers are an essential extension of our workforce. GJFS of Broward is committed to ensuring the volunteers are supported, valued and respected and has procedures in place to promote high standards and excellent customer service to our volunteers.
I agree to serve as a volunteer and commit to the following:
1. To perform my volunteer duties to the best of my ability.
2. To adhere to agency rules and procedures, including record-keeping requirements
and confidentiality of agency and client information.
3. To meet time commitments, or to provide adequate notice so that alternative
arrangements can be made.
4. To attend all volunteer program training meetings as required by the agency.
5. To report any client concerns to the Program Directors.
OATH OF CONFIDENTIALITY
The relationship between Goodman Jewish Family Services (GJFS), clients, donors, staff
and volunteers has a built in component of confidentiality. GJFS has a commitment to
protecting that confidentiality. All volunteers are expected to observe the principle of
confidentiality in obtaining and releasing information about clients. Information about a
client that is made known to a volunteer is to be used only for the purpose of giving service.
By signing below I understand and agree to the following:
- I acknowledge that I have received, read and understand GJFS of Broward's Privacy Policies and practices and agree to comply with these policies and practices.
- All confidential and/or personal health information that I have access to or learn through my affiliation with GJFS of Broward is confidential.
- Under no circumstances, except when required by law, may confidential and /or personal health information be communicated whether within or outside of GJFS of Broward except to other persons who are authorized by GJFS of Broward to receive such information.
- I agree to keep any computer access codes, passwords, confidential and secure.
- I will not lend my access codes or devices to anyone.
I understand that a breach of this oath of confidentiality may result in termination of my volunteer service at GJFS.
PLEASE READ CAREFULLY. THIS IS A LEGAL DOCUMENT WHICH AFFECTS YOUR LEGAL RIGHTS.
VOLUNTEER RELEASE AND WAIVER OF LIABILITY
I, the undersigned (collectively with my successors and assigns, heirs, legal representatives and executors, the "Volunteer"), do hereby execute this VOLUNTEER RELEASE AND WAIVER OF LIABILITY (this "Release and Waiver") in favor of Goodman Jewish Family Services, its successors and assigns, directors, officers, employees and staff (collectively referred to herein as "JFS") for participation in JFS Volunteer Programs (the "Program").
Volunteer desires to participate in the Program and other activities of JFS. In consideration for allowing Volunteer to participate in the Program and other JFS activities, Volunteer does hereby freely execute this Release and Waiver under the following conditions:
Assumption of Risk. Volunteer understands that his or her participation in the Program may include activities which may be hazardous to Volunteer or to Volunteer's property. Volunteer further acknowledges that there are inherent risks in participating in the Program activities, including, but not limited to, physical injury, property damage and death.
Volunteer hereby expressly assumes the risk of injury or harm in these activities and releases JFS and any other participant in the JFS's Programs ("Program Participants") from any and all liability for any claim or demand arising out of, related to, or resulting from Volunteer's participation in the Program, except to the extent that such claim or demand arises out of the negligence or willful misconduct of JFS or any Program Participant.
Release and Waiver. Volunteer hereby releases, waives and discharges any and all liability, claims, demands or rights of action, in law or equity, known or unknown, of whatever kind or nature against Program Participants and JFS arising out of, related to, or resulting from Volunteer's participation in the Program, except to the extent that such liability, claim, demand or right of action arises out of the negligence or willful misconduct of JFS or any Program Participant.
Indemnify and Hold Harmless. Volunteer hereby agrees to indemnify, defend and hold harmless JFS from any and all losses, claims, liabilities or expenses of whatever kind, arising out of, related to, or resulting from Volunteer's participation in the Program, except to the extent that such losses, claims, liabilities or expenses arise out of the negligence or willful misconduct of JFS.
Legal Status of Parties. Volunteer is not an employee or agent of JFS or the Program and Volunteer understands that he/she has no authority to act on behalf of or bind JFS. Volunteer also understands that JFS does not assume any responsibility for providing any assistance to Volunteer, including, but not limited to, medical, health, disability, automobile, or workman's compensation insurance.
Medical Treatment. Volunteer releases JFS and Program Participants from any claim whatsoever which arises or may hereafter arise as a result of any first aid, treatment, or service rendered in connection with Volunteer's participation in the Program, except to the extent such claim arises from the negligence or willful misconduct of JFS or Program Participants.
Volunteer Certifications. Volunteer certifies that he or she is physically and mentally competent to carry out the Program activities.
Photographic Release. Volunteer does hereby grant onto JFS and the Program all right, title, and interest in any and all photographic images, television spots, video or audio recordings, and/or stories, or any part hereof, JFS has taken or made of Volunteer in which the volunteer may be included in whole or in part during the Volunteer's activities with JFS, including, but not limited to, any royalties, proceeds, or other benefits derived from such photographs or recordings and consents to the unrestricted use by JFS of said images and recordings.
Complete Agreement. This Release and Waiver and, if applicable, any addendum executed concurrently with it, set forth the entire agreement between the parties with respect to the subject matter contained herein and it expressly supersedes all previous written and oral communications between the parties. If any provision of this Release and Waiver is found to be unenforceable, the remaining terms shall remain enforceable. With the exception of oral directives by Volunteer to JFS for the purpose of checking additional program boxes or adding additional programs to the signature pages, no amendment, alteration, or modification of this Release and Waiver shall be valid unless executed in writing by both parties to this Release and Waiver.
Binding Effect. This Release and Waiver shall remain in full effect and force and bind the successors and assigns, heirs, legal representatives and executors of the Volunteer.
Other. Volunteer hereby expressly agrees that this Release and Waiver is permitted and governed exclusively by the laws of the State of Florida, irrespective of choice of law principles. In the event any clause or provision of this Release and Waiver is ruled invalid, the invalidity of such clause or provision shall not affect the remaining provisions of this Release and Waiver which shall continue to be enforceable. This Release and Waiver may be executed in multiple counterparts, each of which shall be deemed an original, but all of which taken together shall constitute one and the same agreement. The electronic or facsimile transmission of an originally executed Release and Waiver signature page shall constitute an originally executed Release and Waiver.
Remainder of Page Left Intentionally Blank. Signature Page(s) Follow.
IN WITNESS WHEREOF, I, the undersigned, have carefully read this Release and Waiver of Liability and fully understand its contents. I am aware that this is a release and waiver of liability in favor of JFS and the Program Participants. I am aware that in the event I suffer loss or injury the terms of this Release and Waiver shall apply. Further, I am aware that I have given up substantial rights by voluntarily signing this Release and Waiver.
STANDARD RELEASE FORM
Consent to Use Photograph, and/or Images, Client History or Electronic Recording
This authorization affects your rights in the privacy of your personal information. Please read it carefully before signing.
Goodman Jewish Family Services, ("GJFS") will not condition provision or eligibility for services or benefits, as applicable, on your providing authorization for the requested use or disclosure.
YOU MAY REFUSE TO SIGN THIS AUTHORIZATION
I, the undersigned, hereby consent to the filming/taping/photographing of my image, and/or the recording of my voice, and/or the use of my name and/or likeness or image by GJFS. I also consent to the use, in any lawful manner whatsoever, by GJFS, or its licensees or assignees, of said filming/taping/photographing and/or recording of my voice and/or use of my name, likeness or image, provided that such use shall be solely for the purpose of publicizing and promoting GJFS. I also understand that once my image is distributed or posted on the GJFS website and or social media networks including and not limited to Facebook, Twitter, YouTube, Instagram and LinkedIn and other social media networks that image may be downloaded by any computer user, and that GJFS has no control over the subsequent redistribution or use of such image. I also agree to the sharing of my family history/story for public relations purposes including GJFS newsletters, annual reports, websites, Facebook, Twitter, YouTube, Instagram and Linkedin.
I understand I have the right to revoke this authorization, in writing, at any time, except to the extent that GJFS has taken action in reliance on it. A revocation is effective upon receipt by GJFS of a written request to revoke and a copy of the executed authorization form to be revoked at the address listed above.
This authorization shall expire upon the earlier occurrence of: (a) revocation of the authorization, (b) complete satisfaction of the purposes for which this authorization was originally obtained, to be determined in the reasonable discretion of GJFS, or (c) two (2) years from the date this authorization was executed. Note: Revocation or Expiration of this Authorization does not mean that existing content will be removed or deleted, only that no new or additional content will be used without your permission.
By signing this authorization I acknowledge and agree that any information used or disclosed pursuant to this authorization could be at risk for re-disclosure by the recipient.
I hereby release and discharge GJFS, its officers, directors, employees and agents for and from any and all liabilities and causes of action in connection with the above-mentioned use, and I hold GJFS and its officers, directors, employees and agents harmless from any and all liability in connection with such use.
Check here to show you accept the terms stated above for yourself or for a minor Volunteer for which you are the parental guardian.
