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Volunteer Service Agreement

Please read the following statements carefully and click the corresponding boxes
to complete this form.

If you have questions about any of the items below, please contact
your Volunteer Supervisor.
- The maximum number of form submissions has been reached. This form is currently not available.
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  I agree to serve as a Volunteer for Catholic Charities of the Archdiocese of Dubuque.
  I Agree Please select this field.
  
  Click here to review the Volunteer Handbook .
  
  I agree to provide the services only to the client/placement that I am assigned. I agree to follow the duties that I am assigned and policies in the Volunteer Handbook, the receipt of which are acknowledged by me and are incorporated by this reference (collectively “Agreement”).
  I Agree Please select this field.
  
  In return for my volunteer service, I will receive the appropriate level of training commensurate with my role and evaluation. I am aware that I can bring any questions or concerns to my Volunteer Supervisor. Furthermore, I understand that if I have a problem or conflict with a client, staff member, volunteer, or service provider that relates to my volunteer service, I will follow the Problem Resolution Procedure
  
  Review page 18 of the Volunteer Handbook for the Problem Resolution Procedure.
  I Agree Please select this field.
  
  I understand that anything that I hear, see, or read in the course of my work at Catholic Charities of the Archdiocese of Dubuque is Confidential. I will not repeat, talk about, or communicate in any way anything that was learned about a client of the Catholic Charities of the Archdiocese of Dubuque to anyone who (1) Is not a member of the Staff or (2) To whom Catholic Charities of the Archdiocese of Dubuque is required to provide specific information. Confidentiality is essential to the agency’s respect for the privacy of clients and I agree to abide by it.
  I Agree Please select this field.
  
  I am not covered for injury to myself during my volunteer work and would need to seek coverage under my own health or accident insurance. The primary liability coverage for any volunteer transportation I provide is my own automobile insurance plan.
  I Agree Please select this field.
  
  I understand that Catholic Charities of the Archdiocese of Dubuque may terminate my service at any time if I violate any volunteer program policies or agreements. This agreement will remain in effect unless terminated at the request of either the volunteer or the agency.
  I Agree Please select this field.
  
  I hereby give permission for the use of photographs of myself for publication or use in print and/or electronic promotional materials for Catholic Charities of the Archdiocese of Dubuque and its programs. We need written permission when we take photos to be used in our newsletter, website, on Facebook, or other social media. Checking the Agree box is optional, but doing so would be helpful to us, avoiding paperwork for each photo.
  
  Choosing to be exempt from using your photograph will not affect your volunteer status in any way I agree to the use of my images I do not give permission for my images to be used
  
  I agree on behalf of myself, my heirs, assigns, executors, and personal representatives, to hold harmless and defend Catholic Charities of the Archdiocese of Dubuque, their officers, directors, agents, employees, or representatives associated with my volunteer service, from any and all liability claims, loss or damage arising from or in connection with my participation. I hereby warrant that to the best of my knowledge, I am in good health, and I assume all responsibility for my health and any medical bills incurred.
  I Agree Please select this field.
  
  This Agreement, including the Volunteer Role Description, the Volunteer Handbook and all policies and procedures incorporated therein by reference, expresses all the obligations between the volunteer, supervisor, and Catholic Charities of the Archdiocese of Dubuque. There are no other agreements between them, written or oral, involving the obligations outlined above. If there any changes to the Agreement by Catholic Charities, which may be done from time to time within the discretion of Catholic Charities, I agree to be bound those changes and/or to sign a new Volunteer Service Agreement to reflect those changes as a condition of my continued volunteer activities.
  I Agree Please select this field.
  
  Types Name of Volunteer (Digital Signature) REQUIRED Please fill out this field. Please enter valid data.
  
  Date REQUIRED Please fill out this field. Please enter a date.
  
  Submit
  
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