Please complete this application form if you are interested in becoming a Children's Therapy Center volunteer. Once you complete the form, click the submit button at the bottom.


Basic Information

Please complete this application form if you are interested in becoming a Children's Therapy Center (CTC) volunteer.



Emergency Information

In case of an emergency, CTC keeps information on file that coyuld assist emergency medical personnel. Such information is kept confidential but could be of great importance should an emergency occur. If you would like to share any medical conditions, medications, or allergies that should be known in an emergency, please indicate it below. Also, please provide us with an emergency contact person.



Availability

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





Skills

Children's Therapy Center seeks to match our skilled and diverse volunteers with appropriate opportunities. Please take a moment to tell us about youself so we can better understand your experiences, skills and interests.

List Any Previous or Current Volunteer Experience:


- Organization

- Position/Major Responsibility

- Date of Service (mm/yr)



School/Program Requirements

Are you seeking to fulfill any school or program requirements? If yes, please describe the type, number of hours and when they must be completed by.








Additional Questions

1. How did you hear about the CTC volunteer program?

2. Why would you like to volunteer your time with us?

3. Do you speak any other languages?



Special Accommodations

Do you require any special accommodations in a work environment? If yes, please describe.





Email Preferences

We like to keep volunteers informed of important news, schedules, and volunteer opportunities by email, however 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.



Statement of Confidentiality

It is the policy Children's Therapy Center to require all employees, volunteers, contract personnel, and others in official capacity to safeguard sensitive agency information. Continued employment, volunteering, or any other official capacity is contingent upon compliance with this policy. Sensitive CTC information is defined as all client information that identifies the client, all personal information, medical and treatment information, strategic negotiations, contact list, participant list, names of contributors, the amount of individual contributions, and any other information designated as such. Additionally, all personal information of employees and volunteers must also remain confidential. Each employee, volunteer, contract personnel, and others in official capacity shall sign a written statement agreeing to maintain the confidentiality of the information.


By signing below, I affirm that I have provided true and correct information; that I understand and agree to follow CTC's statement of confidentiality and that I agree to follow all rules, regulations and policies of Children's Therapy Center.


I understand and agree that Children's Therapy Center will conduct a background check on me before I am accepted as a volunteer.


I understand that if any portion of this application is found to be intentionally false, I may be denied the right to volunteer for Children's Therapy Center.