Volunteer Form Your Info First Name * Last Name Address * Address Address Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Phone * Email * Volunteer Type * Community Service Volunteer – individuals who are required to complete Community Service Hours Student Service Learning – students who need to complete Community Service Hours for graduation or an internship Professional Skills Volunteer – individuals who would like to share their skills with our clients through seminars of 30 to 60 minutes Groups – business or organizations who would like to participate in group volunteer events Community Event Volunteer – individuals who would like to help us at community events and donation drives Other - please briefly explainOther - please briefly explain Reason for Volunteering * select oneCourt OrderedSchool/Education RelatedSocial Benefits related Do you have court documents specifying the amount of hours required to volunteer? Yes No Please have these documents with you whenever you come in to volunteer. In order to perform court related volunteer hours, a court document is required. Please return and complete the form when those documents are available. Number of Hours * Please choose your preferred store MD - FrostburgMD - Hagerstown - North PointeMD - Hagerstown - South EndMD - LaValeMD - OaklandPA - GreencastlePA - WaynesboroVA- Mt. JacksonVA - Front RoyalVA - RomneyVA - StanleyVA - WinchesterVA - WoodstockWV - Berkeley SpringsWV - Charles TownWV - KeyserWV - MartinsburgWV - Shepherdstown Please explain what type of volunteer you'd like to be. * Do you speak a foreign language fluently? * Yes No Please list languages you speak fluently Do you speak American Sign Language? * Yes No Could you act as an interpreter? * Yes No Volunteer Agreement VOLUNTEER’S AGREEMENT AND RELEASE FROM LIABILITY Voluntary Participation: I acknowledge that I have voluntarily applied to Horizon Goodwill Industries’ Volunteer Program. I understand that as a volunteer, I will not be paid for my services, I will not be covered by any medical or other insurance coverage provided by Horizon Goodwill Industries, and I will not be eligible for any Workers Compensation benefits. Release: In consideration of the opportunity afforded me to assist in this program, I hereby agree that I, my assignees, heirs, guardians, and legal representatives, will not make a claim against Horizon Goodwill Industries, or any of its affiliated organizations, or either of their officers or directors collectively or individually, or the supplier of any materials or equipment that is used by the project, or any of the volunteer workers, for the injury or death to me or damage to my property, however caused, arising from my participation in the program. Without limiting the generality of the foregoing, I hereby waive and release any rights, actions, or causes of action resulting from personal injury or death to me, or damage to my property, sustained in connection with my participation in the program. I further consent to the unrestricted use by Horizon Goodwill Industries, and/or person(s) authorized by them of any photographs, recordings, interviews, videotapes, motion pictures, or similar visual recording of me. A parent or guardian must sign this form if the volunteer is under the age of 18. In addition, as a volunteer I will not make false or misleading remarks, orally or in writing, about Goodwill, those doing or seeking to do business with Goodwill or its employees. All information regarding Horizon Goodwill Industries, its employees and business operations will be kept confidential and will not leave the premises during or after my volunteer commitment has ended. I also acknowledge that some of our volunteer positions may require a background check, at no cost to me. Do you agree to the release and liability agreement above? * Yes Signature * // Please type your full name to agree to the terms outline above. Apply to Volunteer If you are human, leave this field blank. Δ
