NRS Crisis Volunteer Interest Form

Please complete this interest form if you are interested in becoming a National Runaway Safeline Crisis Volunteer. Once you have provided all required information, please click the "continue" button at the bottom to submit your finished form.


Name and address


Phone Number

Please provide a number that is best to reach you by telephone if needed.



Demographic Information

The following questions are optional. Your responses will be used to provide us with a better idea of the demographic make-up of our volunteers. We also use your birth month and day (but not year) for volunteers for recognition purposes.



Computer Literacy

As part of your volunteer responsibilities you will be interfacing with people digitally. We require all of our volunteers to be comfortable using our computer systems. Please select as many competencies that apply.



Email Address

Our primary way to communicate with our volunteers is via email. Please provide an email address that you use on a regular basis.




How did you hear about us?


Availability

Please select when you are generally available for a 2-4 hour shift



Education/Employment Information

Please provide as much detail as possible, beginning with your most recent school/employer.



Volunteer Experience

Please share the name of the organizations you have volunteered for in the part or currently volunteer for and highlight your primary duties and the dates you volunteered.



References

Please provide the name, address, and telephone numbers of two people to serve as a reference on your behalf who are not related to you.



Emergency Contact Person


Background Check

By submitting this application, I understand that volunteering with NRS is contingent upon completion of a background check.



Liability Clause

The undersigned volunteer (“Volunteer”) desires to provide volunteer services for National Runaway Safeline (“NRS”) and engage in activities related to serving as a volunteer. Volunteer understands that the scope of Volunteer’s relationship with NRS is limited to a volunteer position and that no compensation is expected in return for services provided by Volunteer; that NRS will not provide any benefits traditionally associated with employment to Volunteer; and that Volunteer is responsible for his/her own insurance coverage in the event of personal injury or illness as a result of Volunteer’s services to NRS.

In return for being allowed to participate in NRS volunteer activities and all related activities, including any activities incidental to such participation (“Volunteer Activities”), the undersigned Volunteer or Parent/Legal Guardian of Volunteer if Volunteer is under age 18 (hereafter referred to using “I”, “me”, or “my”) releases and agrees not to sue NRS or its officers, directors, employees, sub-contractors, sponsors, agents and affiliates from all present and future claims that may be made by me, my family, estate, heirs, or assigns for property damage, personal injury, or wrongful death arising as a result of my participation in the Volunteer Activities wherever, whenever, or however the same may occur.

1. Waiver and Release: I release and forever discharge and hold harmless NRS and its successors and assigns from any and all liability, claims, and demands of whatever kind of nature, either in law or in equity, which arise or may hereafter arise from the services I provide to NRS. I understand and acknowledge that this Release discharges NRS from any liability or claim that I may have against NRS with respect to bodily injury, personal injury, illness, death, or property damage that may result from the services I provide to NRS or occurring while I am providing volunteer services.

2. Insurance: I also acknowledge that NRS has not arranged and does not carry any insurance of any kind for my benefit or that of the Volunteer (if Volunteer is under 18), my parents, guardians, trustees, heirs, executors, administrators, successors and assigns. I represent that, to my knowledge, I am in good health and suffer no physical impairment that would or should prevent my participation in Volunteer Activities. Further I understand that NRS does not assume any responsibility for or obligation to provide me with financial or other assistance, including but not limited to medical, health, or disability benefits or insurance. I expressly waive any such claim for compensation or liability on the part of NRS beyond what may be offered freely by NRS in the event of injury or medical expenses incurred by me.

3. Medical Treatment: I hereby release and forever discharge NRS from any claim whatsoever which arises or may hereafter arise on account of any first-aid treatment or other medical services rendered in connection with an emergency during my tenure as a volunteer with NRS.

4. Assumption of Risk: I understand that the services I provide to NRS may include activities that may be hazardous to me. As a volunteer, I hereby expressly assume risk of injury or harm from these activities and Release NRS from all liability.

5. Publicity Release: I grant and convey to NRS all right, title, and interests in any and all photographs, images, video, or audio recordings of me or my likeness or voice made by NRS in connection with my providing volunteer services to NRS.

6. Other: As a volunteer, I expressly agree that this Release is intended to be as broad and inclusive as permitted by the laws of the State of Illinois and that this Release shall be governed by and interpreted in accordance with the laws of the State of Illinois. I agree that in the event that any clause or provision of this Release is deemed invalid, the enforceability of the remaining provisions of this Release shall not be affected.


I have read the above and understand and accept these conditions for all volunteers of the National Runaway Safeline.


By clicking "I agree" below, I certify that I have read and fully understand all terms of the volunteer liability clause.