Please complete this application if you are interested in fulfilling your court-ordered community service as a volunteer with Union Gospel Mission of Salem. Once you complete the form, click the CONTINUE button at the bottom.


Volunteers must be at least 18 years of age.


Personal Information


Emergency Contact


Employment


# of hours required:


Date due for hours:


Availability

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



Christian Ministry

Would you tell us a little bit about your faith background?



Email Preferences

We like to keep volunteers informed of important news, schedules, and volunteer opportunities by email. We will never share your information with any third party. Use the check-boxes below to indicate the types of email you would like to receive.



Volunteer Agreement

STATEMENT OF FAITH


By reading and checking the box below, I acknowledge that I have read the Union Gospel Mission (UGM) of Salem, Oregon Statements of Mission and Faith and am willing and able to assist in carrying out the ministry of UGM while donating my time.


CONFIDENTIALITY


As a volunteer at UGM, I understand that I may work with donor information, staff information, and resident or guest information that may be confidential in nature. I will not discuss this information with anyone who is not directly involved in these areas. I understand that failure to maintain confidentiality may result in immediate release from my volunteer commitment at UGM. The obligation to comply with this policy continues after my volunteer commitment with UGM ends. I understand no pictures are to be taken of clientele without a signed release from the Mission and the client involved.


BACKGROUND


I hereby confirm and warrant that I have not been convicted of or charged with a violent crime, child abuse or neglect, child pornography, child abduction, kidnapping, rape or any sexual offense, nor have been ordered by a court to receive psychiatric or psychological treatment in connection therewith.


PHOTO RELEASE


I, the undersigned, agree to appear in print, online or video to be produced by UGM or any approved agency that the UGM works with, for the purpose of describing or promoting my experience with, and the activities of UGM. I give UGM and its approved agencies my unrestricted permission to reproduce and distribute all photographs, video recordings, sound recordings, and/or interviews taken of me, as well as any artwork (all media) or written material produced by me while associated with Union Gospel Mission of Salem. I understand that there will be no compensation or damages for the use of these interviews, photographs, recordings of video and sound, and personal artwork and/or written and online material.


WAIVER AND RELEASE


I agree to hold Union Gospel Mission of Salem, Oregon harmless from any, and all liability, or cause of action and losses imposed on it in any way relating to or arising out of the Volunteer Agreement, including, but not limited to, liability for personal injuries, whether the liability, cause of action, or loss, is caused by negligence, or Union Gospel Mission of Salem, Oregon negligence or otherwise.


I further release Union Gospel Mission of Salem, Oregon from any, and all liability, claims, demands or actions or causes of action whatsoever arising out of damage, loss or injury I might incur while participating in any of the activities contemplated by the Volunteer Agreement, whether such damage, loss, or injury is caused by the negligence of Union gospel Mission of Salem, Oregon, its offices, agents, servants, employees or otherwise.


I hereby agree that UGM is not responsible for any of my personal items that may be lost or damaged during the volunteer period. As a volunteer, I am not protected by any worker’s compensation insurance, nor do I have any other benefits normally associated with employment.


I have read the information and I certify that the foregoing personal information is true and correct. I authorize UGM to inquire with my employers or references as needed, and I agree that UGM may, at its discretion, terminate my volunteer assignment at any time for any reason. I authorize UGM to perform a background screening for criminal history.