Please complete this application form if you are interested in becoming 55+ RSVP volunteer. Once you complete the form, click the Continue button at the bottom.

Contact Information


Email Preferences

We like to keep volunteers informed of important news, schedules, and volunteer opportunities by email, however, we will not send you any email you prefer not to receive. Use the checkboxes below to select the kinds of email you would like to receive from us.


Demographic Information

To be a part of the RSVP program you must confirm your age of 55+. All other demographic information you may optionally provide. This information is used only to help us get a better idea of the overall demographics of our volunteers.


Skills


Interests/Hobbies/Clubs/Groups


Physical considerations for assignments


Emergency Contact Information


Priorities


Availability

Please indicate the days and times you are usually available to volunteer.


Driver's License and Insurance

Driver's License and Insurance is required if you wish to be a Medical Transportation Volunteer Driver.


Beneficiary Information

Beneficiary for 55+ RSVP Supplemental Accident Insurance:
If there is no surviving beneficiary, loss of life benefits will be paid in one sum to this covered volunteer’s estate.


Our Policy

Equal Opportunity will be a fundamental principle of this organization, where volunteering is based upon personal capabilities and qualifications without discrimination of race, color, religion, gender, age, national origin, sexual orientation, disability, or any other protected characteristics as established by law.


Volunteer Commitments:

• Release of Information: I understand the information provided on this form may be disclosed for the purposes of volunteerism.

• Confidentiality: I agree to keep all information about clients, volunteers or other individuals obtained while volunteering confidential.

• Insurance: If I use my car in volunteer service, I certify that I carry, at a minimum, the state required liability insurance.

• Volunteer Assignment: I understand my responsibilities as a volunteer. If a job description is needed, I will contact the 55+ RSVP office.

• Education/Marketing: I give 55+ RSVP/UWJWC permission to use my name/photo for education/marketing purposes.

• Release and Waiver I desire to work as a volunteer for 55+ RSVP – a program of United Way of Johnson & Washington Counties (UWJWC) and engage in the activities related to being a volunteer (the “Activities”). I understand that the Activities may include working for a community partner or direct services of 55+ RSVP.

I hereby and freely, voluntarily and without duress, execute this Release under the following terms:

Release and Waiver: I hereby release and forever discharge and hold harmless 55+ RSVP/UWJWC, its directors, employees and consultants from any and all costs, liabilities, claims and demands of whatever kind or nature, either in law or in equity, which arise or may hereafter arise from my participation in the activities on behalf of 55+ RSVP/UWJWC.

I understand that that this Release discharges 55+ RSVP/UWJWC from any liability or claim that I may have against 55+RSVP/UWJWC or otherwise. I also understand that 55+ RSVP/UWJWC does not assume any responsibility for or obligation to provide financial assistance or other assistance, including but not limited to medical, health, disability, or automotive insurance in the event of injury or illness. Each volunteer is expected and encouraged to obtain his or her own medical or health insurance coverage.

I understand that I am not an employee of 55+ RSVP/UWJWC, the sponsoring agency, or of any agency where I may volunteer. I am under no obligation to accept or continue any assignment unless I choose to do so.

I affirm that the information that I have provided is accurate and that I have read and agree to the statements above.