Catholic Charities Adult Day Services San Francisco

Thank you so much for your interest in helping the most vulnerable members of our community. All your information is confidential and not shared with anyone or any entity outside Catholic Charities San Francisco. Please fill out this application and we will be in touch shortly to connect you with a volunteer opportunity.

Name and address

First name:

Last name:

Title:

Street 1:

Street 2:

Street 3:

City:

State:

* Zip: *

Home phone:

* OK to call me here

Cell phone:

Email address:

Emergency Contact

In case of an emergency, we must be able to reach someone. Please provide the best person to contact.

First name:

Last name:

Home phone:

Cell phone:

Email address:

Relationship:

Demographic Information

You may optionally provide the following information. It is used only to help us get a better idea of the demographic make-up of our volunteers.

Birthday:

Age range:

Gender:

Education:

Ethnicity:

Availability

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

Education

Enter the highest level of education achieved

Major degree:

School:

High school:

College:

Special Skills

Please let us know what skills you have.

Languages Spoken

Please tell us what languages you speak

Password

Enter the password you will use to log into the volunteer information center

Please enter a password that:

Is between 8 and 30 characters long

Password:

Confirm password:

Do you have a Parish affiliation? If so which one?

Where do you work and/or attend school at?

How did you hear about this opportunity?

Release of Liability, Confidentiality and Media

"By signing this signature form I agree to following: RELEASE OF LIABILITY: I understand the risks present in volunteer duties and freely assume those risks and agree to release Catholic Charities, its officers, agents and employees from and against all claims for injury, loss, or danger to me/my child as a result of such duties.

PHOTOGRAPHIC RELEASE: I grant my permission for Catholic Charities to use photographs and/or videos containing my/my childs likeness. These photographs may be used for Catholic Charities programs publicity, newsletters, social media, marketing and development pieces, and for other promotional purposes.

CONFIDENTIALITY: I, the undersigned, acknowledge both a legal and ethical responsibility to protect the privacy of Catholic Charities’ clients, staff, and volunteers. I understand that the indiscriminate review, use or disclosure of client, employee, or organizational information, from any source regarding clients, staff or volunteers is expressly prohibited.

I hereby agree not to divulge any information or records concerning any client, volunteer or staff member, without proper authorization.

I recognize the unauthorized release of confidential information may make me subject to a civil action; I further understand that unauthorized disclosure of confidential information may be grounds for dismissal from the Catholic Charities volunteer program.

CIVIL RIGHTS: Volunteers may not discriminate on the basis of any individuals race, color, citizenship status, national origin, ancestry, gender, pregnancy, sexual orientation, gender identity or expression, genetic information, age, religion, creed, physical or mental disability, marital status, veteran status, political or religious affiliations, or any other characteristic protected by law (Protected Status).

I Agree

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