Volunteer Request Form

Name:*
Address:*
E-mail:*
Please describe any particular opportunity, program or special event you are applying to volunteer for:*
When are you interested in volunteering your time?

CRIMINAL BACKGROUND CHECK CONSENT FORM

United Methodist Community House makes an active effort to prevent child abuse and provide a safe environment for our members, program participants, guests, employees, and volunteers.

Even though we may know you well, UMCH reserves the right to conduct a criminal background check on anyone who applies to volunteer within our programs or facilities. As a present or prospective volunteer of United Methodist Community House, you understand that it is the policy of the organization to secure criminal history information as part of the volunteer screening process using the information provided below. You will be asked to present picture identification prior to starting as a UMCH volunteer.

Maiden name or name previously used:
Birthdate:*
 / 
 / 
Are you age 14 or older?
Driver's License Number:

By completing this application, you understand that the above information is required by the Central Records Division of the Michigan State Policy, Lansing, Michigan; and you authorize United Methodist Community House to utilize the above information for the sole purpose of conducting a criminal history file search.

Have ever been convicted of an offense involving the abuse or neglect of children?*
Have you ever been convicted of a felony criminal offense?*
If yes, please explain:
Have you resided in a state other than Michigan within the last five (5) years?*

VOLUNTEER ETHICAL BEHAVIOR STANDARDS
As a volunteer with the UMCH, you will not:
1) Participate in sexual activity with any minor program participant whether consensual or non‐consensual
2) Strike or otherwise physically restrain or restrict the movement of program participants unless essential for their safety and protection. You will notify your supervisor in the latter case
3) Release any confidential information without permission to do so
4) Provide program participants with any forms of drugs, legal or illegal, unless authorized to do so
5) Misrepresent your credentials and provide services that you are not qualified or authorized to provide
7) Be alone with a single child in an isolated situation where you cannot be observed by other staff and children. The only exception to this would be toileting or medical emergencies, in which case another staff
person should be notified.

Violations of the above will result in an immediate suspension. Should the allegations be substantiated, permanent removal from the volunteer program will result. Should your behavior be illegal, proper authorities will be notified.

HARASSMENT POLICY
It is the policy of the United Methodist Community House to expressly forbid any forms of harassment. The term "harassment" includes, but is not limited to: slurs, jokes, or other verbal, graphic, or physical conduct which relates to an individual's race, color, sex, religion, nation origin, citizenship, age, or handicap. Harassment also includes unwanted sexual advances, requests for sexual favors, unwelcome or offensive touching, or other verbal, graphic, or physical conduct of a sexual nature.

Volunteers who feel they are being harassed in any way by an employee, member, vendor, or other volunteer should inform their immediate supervisor or the CEO. It is the individual's responsibility to bring such concerns to the proper person. Any and all concerns will be handled immediately and kept confidential.

VOLUNTEER WAIVER
WAIVER: I understand that the United Methodist Community House assumes NO responsibility for injuries of illnesses which I may sustain as a result of my physical condition or resulting from my participation in any volunteer activities, the use of any equipment, exercise, or other activities. I expressly acknowledge that I assume the risk for any and all injuries and illnesses which may result from my participation in these activities. I hereby voluntarily release and discharge the United Methodist Community House, its agents, servants,
and employees from any and all claims for injury, illness, loss, or death which I may suffer as a result of my participation in these volunteer activities.

I understand that the United Methodist Community House in NOT responsible for personal property that is lost, stolen, or damaged while volunteering on behalf of the organization.

I understand that no accident or medical insurance is provided by the United Methodist Community House to its volunteers.

I give my permission to the United Methodist Community House to use, without limitation or obligation, photographs, film footage, or tape recordings which may include my image or voice for purposes of promoting the organization and its programs.

ACCEPTANCE: I acknowledge the waiver and accept the conditions set fourth by the above policies. I authorize the United Methodist Community House to use the above information for the purpose of obtaining criminal background information.

Signature (type in your name):*
Today's Date:*