Horton's Kids Volunteer Application

Page 1

General Information

First Name

Last Name

Phone Number

555-555-5555

Date of Birth

Mailing Street

Mailing City

Mailing State

Mailing Zip/Postal Code

Email

How did you hear about Horton's Kids?

Please specify

Please specify who

Please specify which event

Please specify and include location

Gender

What are your pronouns?

He/Him/HisShe/Her/HersThey/Them/TheirsPrefer not to share

Race/Ethnicity

Volunteer Interests and Experience

Is this your first time volunteering with us?

How long have you been volunteering with us?

If you would like to be paired with the same students as previously, please list their names here:

List skills that could be shared with Horton's Kids:

Special Training and Certifications (i.e. First Aid, CPR)

Community Involvement and Affiliations (i.e. involvement with other Volunteer, Service, Athletic Groups)

Please describe your experience working with diverse populations.

Employer

Which one best describes you?

Employer

Position

would your company be interested in group volunteering or hosting a donation drive at your workplace?

School Name

What Year are you in?

Age group

Please check below any/all age groups you are open to working with.

Elementary School (kindergarten through 5th grade)Middle School (6th through 8th grade)High School (9th through 12th grade)Other

Other

Type of Volunteering

Are you interested in Tutoring/Mentoring (Working with kids' afterschool on weekdays)

YesNo

Are you interested in One Off Events (Back to School Bash, Holiday Helpers, Home Runs for HK, etc)

YesNo

Priority

which is more important for Horton's Kids to prioritize when matching you with a volunteer slot?

The statements contained herein are true and complete, to the best of my knowledge. I authorize investigation of all statements made in this application. I understand that I shall have no right to examine any references obtained or information gathered pursuant to my application. I release Horton’s Kids, Inc. and each individual acting on its behalf from all liability relating to the investigation of the statements contained herein. I will abide by the Code of Ethics for Volunteers, as amended from time to time.

Applicant Signature

Date

Page 2

CODE OF ETHICS

1. Volunteers will never leave a child unattended.

2. Except during an emergency situation, a volunteer is not to be alone with children and is never to be alone with one child.

3. Fraternizing (socializing or associating) with program participants who are under the age of 18 outside of activities sponsored by Horton’s Kids is forbidden (such as babysitting, private lessons, etc.). Any exception to this policy requires written approval by the President or designee.

4. Volunteers will portray a positive role model for youth, including but not limited to, maintaining an attitude of respect, loyalty, patience, courtesy, tact, and maturity.

5. Volunteers must treat all children with respect and consideration. A volunteer may not treat a child differently because of that child’s race, color, religion, sex, national origin, age, physical handicap, personal appearance, sexual orientation, family responsibilities, source of income, or place of residence, except that accommodations may be made to promote a child’s participation in activities sponsored by Horton’s Kids.

6. Volunteers will not abuse children. Examples of prohibited abuse include:

a. Physical Abuse – strike, spank, shake, slap

b. Verbal Abuse – humiliate, degrade, threaten

c. Sexual Abuse – including inappropriate physical contact

d. Mental Abuse

7. Volunteers will use positive techniques for guidance, including redirection, anticipation of and elimination of potential problems, positive reinforcement and encouragement rather than competition, comparison or criticism.

8. Using, possessing or being under the influence of alcohol or illegal drugs during activities sponsored by Horton’s Kids is not allowed.

9. Smoking or using tobacco products in the presence of children or parents during activities sponsored by Horton’s Kids is not allowed.

10. Volunteers will not use profanity in the presence of children or parents.

11. Volunteers must appear clean, neat, and appropriately attired.

12. Volunteers will refrain from intimate displays of affection toward others in the presence of children, parents and other volunteers.

13. Volunteers must be free of physical and psychological conditions that might adversely affect children’s health, including significant fever or readily contagious conditions.

I agree to abide by the Code of Ethics, as amended from time to time. I understand that any violation of the Code of Ethics may result in my exclusion from future activities sponsored by Horton’s Kids. Click here to enter text

Volunteer Signature

Date

Page 3

Volunteer Waiver & Release of Liability

This Volunteer Waiver and Release of Liability (“Agreement”) is entered into by the undersigned volunteer (“Volunteer”) and Horton’s Kids, Inc., a nonprofit organization (“Horton’s Kids”).

1. Volunteer Acknowledgment

I understand that volunteering with Horton’s Kids may involve working with children, families, staff, and other community members in various settings, including but not limited to: tutoring, mentoring, events, field trips, and community service activities. I agree to conduct myself in a safe, respectful, and professional manner at all times.

2. Assumption of Risk

I understand that volunteer activities may include physical activity, transportation, interaction with the public, and other activities that may carry risks of injury, illness, or property damage. I voluntarily assume full responsibility for any and all risks, whether foreseeable or unforeseeable, that may arise from my participation as a volunteer.

3. Health & Safety

I certify that I am physically and mentally able to participate in volunteer activities. I agree to follow all safety instructions, program guidelines, and Horton’s Kids policies, including background checks, child safety procedures, and confidentiality agreements.

4. Release of Liability

In consideration for being permitted to volunteer with Horton’s Kids, I release and hold harmless Horton’s Kids, its directors, officers, employees, agents, partners, and volunteers from any and all claims, demands, damages, losses, or expenses (including attorney’s fees) arising from or connected with my participation in volunteer activities, except to the extent caused by the gross negligence or willful misconduct of Horton’s Kids.

5. Confidentiality & Privacy

I understand that in the course of my volunteer work, I may have access to confidential information, including but not limited to personal information about children, families, and staff. I agree not to disclose or use any such information except as required in the performance of my volunteer duties.

6. Background Check Authorization

I understand that as a volunteer working with children, I may be required to undergo a background check prior to participation. I consent to Horton’s Kids conducting such checks as required by law or organizational policy.

7. COVID-19 & Health Protocols

I acknowledge that Horton’s Kids follows public health guidelines to protect volunteers and participants. I agree to comply with any health screenings, vaccination requirements, or mask mandates in place at the time of my service.

8. Termination of Service

I understand that Horton’s Kids reserves the right to end my volunteer service at any time, for any reason, consistent with applicable laws.

Media Release (Optional) to Horton’s Kids using photographs, video, or audio recordings of me taken during volunteer activities for promotional, educational, or fundraising purposes, without compensation.

I consentI do not consent

Volunteer Signature

Date

Name (please print)

Please list below any restrictions that may hinder activities or special accommodations you may need:

AUTHORIZATION AND RELEASE

First Name

Last Name

I authorize and request every person, firm, company, corporation, governmental agency (including any department of motor vehicles), law enforcement agency, court, association, or institution having any control of any documents, records, or other information pertaining to me, to furnish Horton’s Kids, Inc. any such information, including documents, records, charges, or complaints filed against me, including any complaints erased by law, whether formal or informal, pending or closed, or any other data pertinent to my fitness to work directly with children; and to permit Horton’s Kids, Inc. or any of its agents or representatives to inspect and make copies of such documents, records, or other information. The records, however, will not include any information with respect to juvenile offense.

I hereby release, discharge, and exonerate Horton’s Kids, Inc., its agents and representatives, and any person so furnishing information from any and all liability of every nature and kind arising out of the furnishing or inspection of such documents, records, and other information or the investigation made by Horton’s Kids, Inc.

Signature of Applicant

Date