Rotary DRAI Volunteer Application
Please fill out this brief form to help with translation for the Disaster Relief Assistance for Immigrants. We welcome the valuable help of our Rotary Partners.
Someone will contact you within three business days.
Name and address
First name:
*
Last name:
*
Title:
Choose
Dr.
Mr.
Mrs.
Ms.
Street 1:
*
Street 2:
Street 3:
City:
*
State:
Choose
CA
*
Zip:
*
Home phone:
*
OK to call me here
Cell phone:
*
Email address:
*
Language beside English fluently spoken
Please state what languages you speak fluently
Availability
Sun
Mon
Tue
Wed
Thu
Fri
Sat
Morning:
Afternoon:
Evening:
My availability is:
Choose
One time
Ongoing
Ongoing, except between these dates
Only between these dates
to:
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
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.
Disaster Relief Assistance for Immigrants (DRAI) Confidentiality Agreement
This Confidentiality Agreement must be signed by any person conducting application intake, making eligibility determinations, access to confidential, sensitive, or personally identifying information (PII) of DRAI applicants and/or approved applicants.
I the volunteer applicant certify that I am providing services related to the Disaster Relief Assistance for Immigrants (DRAI) Project as an employee, independent contractor or volunteer providing services to __CATHOLIC CHARITIES OF SAN FRANCISCO.
I agree to use, protect and preserve personal and confidential applicant information in accordance with relevant state and federal laws and the terms and conditions of the Grantee’s Agreement. I further agree that a breach of confidentiality and privacy may result in disciplinary actions, up to and including termination of my employment or contract.
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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