What's your email address?

Your information


Required fields are marked with an asterisk (*). One of the fields below is a file upload/attachment, the file size must be less than 10MB.
Date of Submission *

A valid date as MM/DD/YYYY (for example: 11/30/2015)
First Name *
Last Name *
Mobile Phone *

For example, 123-456-7890
SMS/text messaging: By providing your mobile number and checking the box below, Communities In Schools of Nevada will be allowed to send you SMS (text) messages relating to their volunteer activities. To opt-out, reply STOP to any SMS message OR return to this form and uncheck the box.
Title (Mr/Mrs/Dr; etc.)
Address
Address 2
City
State
Zip/Postal
Birthday *

A valid date as MM/DD/YYYY (for example: 11/30/2015)
Organization/Employer
Do you have a current valid driver's license? *
Have you ever been convicted of a felony? *
Please explain. *
I understand and accept that submitting this application form does not automatically register me as a Communities In Schools of Nevada volunteer. *
I understand and accept that there may be certain qualifications I must meet, including the acceptance of established volunteer policies and procedures before I may begin volunteering. *
I attest that the information I have provided on this application form is true and accurate. *

Waiver

In signing this form, I understand and agree to the following terms and conditions related
to volunteering my services to: Communities In Schools of Southern Nevada

I recognize that, as a volunteer I represent the above organization to the public. I accept the responsibility for this status and
will conduct myself in a professional manner. I will be clean and sober when conducting business as a representative of this
organization.

I will not participate in and will report any and all instances of any sort of harassment, exploitation, and or intimidation. I will
work to maintain an atmosphere of physical and emotional safety for everyone associated with the organization: (employees,
volunteers, clients and visitors.)

I agree to maintain the confidentiality of all volunteers, clients, and donors about whom I have personal and identifying
information.

I agree to honor the commitment length and frequency of service that I make to the organization. I agree to provide as much
advance notice as is possible in the event that I will be absent from my volunteer shift. I agree to update my personal
information and emergency information as changes occur.

I am aware that as a volunteer I expose myself to potential hazards which include but are not limited to: kitchen accidents,
cuts, burns, back injury from lifting, car accidents, property damage or injury to others in car accidents, falls, muggings, viruses,
bacterias, communicable diseases or infections, etc. Potential hazards have been explained to me. I am voluntarily
participating in this service with the knowledge of the potential hazards involved and hereby agree to accept any and all risks of
injury.

I agree to adhere to any necessary guidelines in place during my volunteer assignment including: hand washing, sanitizing
work stations, coughing and sneezing into a tissue, wearing a facial mask and/or gloves. I will adhere to CDC guidelines at all
times. I will immediately notify a CIS staff member if I become unwell during service. I agree to cancel my volunteer service if I
am sick, injured or running a fever.

I agree that my assignees, heirs, distributes, guardians and other legal representatives will not make a claim against, or sue for
injury or damage resulting from the negligence or other acts, however caused, by any employee, agent, or volunteer contractor
of the organization as a result of my participation as a volunteer. I hereby release Communities In Schools of Nevada from all
actions, claims, or demands that I, my assignees, heirs, guardians and legal representatives now have or may hereafter have
for injury resulting from my participation as a volunteer.

If my volunteer service includes driving an automobile, I acknowledge that I have both a valid drivers license and automobile
liability insurance policy as required by state law. I agree to maintain my license and insurance in good standing for my entire
tenure as a volunteer for the organization. I am knowledgeable of and agree to abide by local and state traffic laws. I agree
not to drive while under the influence of alcohol, drugs and/or other intoxicating substances.

I have carefully read this agreement and fully understand its contents. I am aware that this is a release of liability and I sign it
of my own free will.