Volunteer Sign up Sheet - Amazon S3

Volunteer Sign up Sheet

Thanks for wanting to volunteer with Refresh Mobile Showers!

First name:

Last name:

Street:

City:

Postal Code:

Cell phone:

Email address:

Date of birth:

Gender:

Church affiliation (If any):

Pastor��s Name:

Why Refresh Mobile Showers?

What made you interested in volunteering with Refresh Mobile Showers?

Background Check Authorization

All volunteer applicants over the age of 18 must consent to a criminal background check before

they can volunteer.

In the interest of fulfilling our mission, as well as the safety and well-being of those whom we are

called to serve, King Road M.B. Church reserves the right to deny any individual from serving as

a volunteer.

Note: if you do not authorize, you will be unable to volunteer.

Confidentiality Agreement

Confidentiality can be a life or death issue for people who are homeless. As a volunteer of the

Refresh Mobile Showers Program, I agree to hold information regarding people I encounter

while volunteering and their condition in confidence. This includes not sharing camp locations.

Conversations about individuals being served and their situations, without their consent are

violations of the trust, respect and privacy to which they are entitled.

? Do not share your personal contact information with individuals being served (address, phone

number, email)

? Do not transport individuals being served in your personal vehicle.

? Connecting and building healthy wholesome relationships between volunteers and individuals

being served is encouraged. It is important that these relationships be developed carefully and

respectfully, recognizing that many individuals being served are emotionally, socially, spiritually,

and physically vulnerable. With this in mind, please do not visit camp locations outside of

Refresh Mobile Showers events.

Background Check Authorization and Confidentiality

I authorize King Road M.B. Church to run a criminal background check and I agree to abide by

the Refresh Mobile Showers confidentiality agreement (as seen above).

By signing this form you agree with the information above

Print name

Signed

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