Innvision


	July 28, 2009

How You Can Help

Holiday 2008

Individual Volunteer Online Form

Please fill out the appropriate information and complete the volunteer agreement at the bottom of this form, then press the SUBMIT button. Required information is identified in red. Allow at least two weeks for your volunteer form and agreement to be processed. We Thank You for your support!

Contact Information
First Name:
Last Name:
Address:
City:
State:
Zip Code:
Email Address:
Phone Number:	( )
May we email you from time to time?	Yes No
Would you like to receive our newsletter?	Yes No
How would you like to receive our newsletter?	Email Printed
I am interested in hearing about issues involving the following groups (please check all that apply):
Women Mentally Ill Men Children Families InnVision

How did you hear about InnVision?


Volunteer Information
Are you Employed?
Employer:
Job Title:
Address:
City:
State:
Zip Code:
Work Phone:	( )
Have you ever been convicted of a felony?	Yes No
If yes, explain further:
Gender:	Male Female

What is your highest level of education?
Currently in High School High School/GED
Some College AA BA/BS/BE Masters Ph.D.
In what field is your degree?
If you are a high school student, What year will you graduate?
Are you a member of a school or community club? Please provide your club name:
Please list the languages in which you are fluent:
If you have any previous volunteer experience, please list:

Days and Times you are available: (Example: 11am to 4pm)
MON
TUE
WED
THUR
FRI
SAT
SUN

Please check off all volunteer activities of interest to you (Check as many as apply):
Childcare Assistant Clothes Closet Computer Lab Monitor Computer Trainer Data Entry Delivery Driver Food Service Front Desk/Receptionist Fundraising/Events Graphic Artist Janitorial	Job Training Landscaping Maintenance Office/Clerical Painting Structures Public Relations Teaching Tutoring
Other Activities:
List skills relevant to desired volunteer work:


Emergency Information
Emergency Contact Name:
Emergency Contact Phone Number:
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Volunteer Agreement
Please read the Volunteer Agreement statement and indicate your intent at the bottom.
Agency/Volunteer Agreement This agreement is intended to indicate the seriousness with which we treat our volunteers. The intent of the agreement is to assure you of both our deep appreciation for your services and to indicate our commitment to providing you with a productive and rewarding volunteer experience with InnVision. I. Agency We, InnVision, agree to accept your services, and to commit to the following: 1. To provide adequate information, training and supervision for the volunteer to be able to meet the responsibilities of his/her position. 2. To be receptive to the volunteers� comment(s) regarding ways in which we might mutually better accomplish our respective tasks. 3. To treat the volunteer as an equal partner with agency staff, jointly responsible for completion of the agency mission. II. Volunteer I will read and will adhere to the policies and procedures established in InnVision�s Volunteer handbook and agree to serve as a volunteer for InnVision. I understand that this agreement may be canceled at any time at the discretion of either of the parties. III. Waiver of Liability I understand that as a volunteer I am not eligible for Worker�s Compensation Benefits, Unemployment Insurance benefits, medical, dental or any other insurance coverage. I understand that InnVision cannot be liable for any injuries or illnesses that my dependent(s) or I may suffer while as a volunteer for the agency. I expressly waive any such claim for compensation or liability on the part of InnVision in the event of such injury or medical expense.
IV. Agreement I Agree I Do Not Agree Please print your full name and date this agreement: Full Name: Date:
Should you have any questions contact us by submitting your volunteer questions?

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