Phase I Volunteer Application Form
PLEASE READ PRIOR TO FILLING OUT THIS FORM:
Hey! Thanks for your interest in volunteering with us! During Phase I of our re-opening, we will be requiring our volunteers to be fully-vaccinated. Please complete this application form to access our volunteer portal. Once you complete the form, click the "Continue" button at the bottom.
If you are applying to volunteer as a group, please indicate "Group" under Type of Volunteer.
Basic Information
First name:
*
Last name:
*
Preferred Name:
*
Type:
Choose
Club/ Organization
Court/ Judiciary Community Service
Intern
Other
School Group
Service Learning/ Class Credit
*
Kind:
Individual
Group
Group name:
*
How Many Members?:
*
Participation:
If your group will serve more than once, you will usually send...
The same volunteers each time
Different volunteers each time
Street 1:
Street 2:
Street 3:
City:
State:
Choose
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip:
Home phone:
OK to call me here
Cell phone:
OK to call me here
Email address:
*
Date of birth:
Month
Jan
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Day
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2023
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1919
1918
(year optional)
Pronouns:
Choose
He/His/Him
Other/Prefer not to say
She/Her/Hers
They/Them/Theirs
*
Emergency Contact
First name:
Last name:
Home phone:
Work phone:
Relationship:
Choose
Co-worker
Daughter
Father
Friend
Mother
Neighbor
Son
Spouse
Supervisor
Criminal History
Have you ever been convicted of a crime? [If yes, please explain the nature of the crime and the date of the conviction and disposition.] Conviction of a crime is not an automatic disqualification for volunteer work.
Criminal History:
Choose
No
Yes
*
Date of Conviction:
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
1
2
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Year
2043
2042
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2039
2038
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2036
2035
2034
2033
2032
2031
2030
2029
2028
2027
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2025
2024
2023
2022
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2020
2019
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2013
2012
2011
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2008
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2005
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2002
2001
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1995
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1993
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1991
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1989
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1981
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1978
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1953
Type of Conviction:
*
If you would like to provide further explanation, please do so in the field below:
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.
What kinds of email would you like to receive?
Volunteer Updates
Weekly (usually Thursday afternoon)note regarding volunteer opportunities and F.A.R.M. Cafe community information.
Recruitment appeals
Schedule reminders
Volunteer Waiver
I understand that my work is voluntary and that some risks may occur due to the nature of the work in F.A.R.M. Cafe or at a F.A.R.M. Cafe-sponsored event. I understand and assume these risks and hereby release F.A.R.M. Cafe and its officers, directors, employees, affiliates, or agents from any and all liability regarding the volunteer effort with F.A.R.M. Cafe. I agree to save and hold each of them harmless from and against all claims, costs, expenses, demands, and actions with the volunteer effort.
I agree:
*
COVID-19 Volunteer Health Policy
F.A.R.M. Cafe is committed to a healthy and inclusive community. We are a community first, and a restaurant second. The virus that causes COVID-19 can be spread to others by infected persons who have few or no symptoms. We are following the federal, state, and local guidelines to help ensure your safety and the safety of our staff and volunteers. For Phase I of our reopening, we are adopting the following minimum health protocols.
The Staff at F.A.R.M. Cafe are all fully vaccinated. At this time, volunteers are required to be fully-vaccinated. (If you need more information about vaccination opportunities email volunteer@farmcafe.org). As we continue to monitor COVID-19 conditions, we will update and evaluate this policy. These minimum health protocols are not a limit on the health protocols that individuals may adopt. Individuals are encouraged to adopt additional protocols consistent with their specific health needs and circumstances.
Volunteers must be in masks at all times. In addition, we will continue to meet our local health department standards for safety and sanitation. We ask all volunteers to maintain social distancing from others at all times (even with the appropriate use of face coverings); and significant and active effort should be used to respect the space of other guests. The face covering should cover the nose and mouth. If you do not have a mask or face covering, one will be provided to you.
We ask volunteers to self-screen prior to each shift F.A.R.M. Cafe for any of the following new or worsening signs or symptoms of possible COVID-19:
-Cough, Shortness of breath, Chills, Muscle Pain, Headache, Sore throat, Loss of taste/smell, Diarrhea, Fever, Contact to a person who has tested positive for COVID-19
We all need to work together to help ensure the health and safety of our community so that we can continue our mission of Feeding All Regardless of Means.
I agree:
*
Health Policy Agreement
By clicking the "I agree" box, I understand that I agree to the following statements:
Volunteer Health Policy
1. I agree to report to the manager before volunteering when I have:
Diarrhea
Vomiting
Jaundice (yellowing of skin and/or eyes)
Sore throat with fever
Infected cuts or wounds, or lesions containing pus on the hand, wrist, or any exposed body part (such as boils and infected wounds, however small)
Or any other potentially contagious illness
2. I agree to report to the manager before volunteering when I have or have been exposed to any of the illness listed below:
Norovirus
Salmonella Typhi (Typhoid Fever)
Shigella spp. Infection
E. Coli infection (Escherichia coli O157:H7 or other EHEC/STEC infection)
Hepatitis A
COVID-19
Or any other contagious illness
Exclusions and Restrictions from Volunteering
If you have any of the symptoms or illnesses listed above, you may be excluded* or restricted** from volunteering at F.A.R.M. Cafe.
* If you are excluded you are not allowed to volunteer.
**If you are restricted you are allowed to volunteer, but your duties may be limited.
Please indicate that you have read and agree with this policy by checking off 'I Agree' on your volunteer application form.
You may be provided with a copy of this Agreement upon request.
I agree:
*
Volunteer Meal Exchange Policy
F.A.R.M. Cafe is a 501(c)(3) non-profit that builds a healthy and inclusive community by providing high quality & delicious meals produced from local sources when available, served in a restaurant where everybody eats, regardless of means.
In order to sustain the mission of F.A.R.M. Cafe, and because the restaurant operates almost exclusively on volunteer labor, we have established a Meal Exchange Policy that provides guidelines for meal exchange eligibility.
Volunteers include those who work
• in exchange for a meal (those of lesser means)
• for class credit (or other school related credit)
• for court/judiciary appointed community service
• to donate their time in order to “pay-it-forward”
Our meal exchange guidelines are as follows:
• Those who cannot pay are asked to volunteer at the restaurant for one hour in exchange for a meal.
• Those working for class credit or court/judiciary community service are NOT eligible for a shift meal. However, if you cannot make a monetary contribution for your meal, you may work an additional hour (which will not count toward your class credit or court/judiciary community service) in exchange for a meal.
• Those donating their time are eligible for a shift meal after having worked at least three consecutive hours. If you can afford to make a monetary contribution for your meal, we ask that you consider doing so. This helps us to continue providing meals to those volunteers and clientele who may not be able afford to pay for their meal.
I have read the Meal Exchange Policy:
*
Agreement statement
I understand and agree that submitting this application form does not automatically register me as a F.A.R.M. Cafe volunteer, and that there may be certain qualifications I must meet, including the acceptance of established volunteer policies and procedures before I may begin volunteering.
By submitting this form, I attest that the information I have provided on the form is true and accurate.
I Agree
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