If you’d prefer to print out and sign your application manually, you can do so here: Download All 532 KB Volunteer Application Name:* First Last Preferred Name/Nickname, if other than above: First Home Telephone:Cell Phone:Email:* Date of Birth:* MM slash DD slash YYYY Present Address:* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code How long have you been at this address?Less than two years2 years or moreThird ChoicePlease provide your previous address. Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code How long did you live there? Employment InformationName of Employer: Title/Position: Are you Currently a Student?* Yes No If so, which school do you attend & what is your focus of study? Are you a member of a civic/social club, if so which one(s)? Racial or Ethnic Identity: White, non-Hispanic Hispanic/Latinx/Chicanx Black/African American/of African Decent Asian/Pacific Islander Native American/American Indian/Indigenous/First Nations Other (used for statistical purposes. Please mark all that apply)Please write in a term that describes your identity: Gender Identity: Female Male Other (used for statistical purposes. Please mark all that apply)Please write in a term that describes your identity: Educational Background/Training:Volunteer Experience:Organization/AddressPosition/ResponsibilityDate(s) of Services Please list 3 professional of personal references that we may contact, if needed.NameEmailRelationship Have you ever been asked to relinquish a volunteer position?* Yes No Are you currently charged with a felony, including but not limited to criminal neglect, abuse or assault?* Yes No Have you ever been convicted of a felony, including but not limited to criminal neglect, abuse or assault?* Yes No How did you hear about Tu Nidito/this volunteer opportunity? Why are you interested in volunteering for Tu Nidito?Which volunteer position(s) are you interested in:* Bereavement Support Group Facilitator One on One Support Volunteer Internship Office Support Events Board of Directors What special skills/experience/interests would you like to share with Tu Nidito as a volunteer?*Do you speak, sign, read or write any languages other than English? If so, which language(s) and what is your level of fluency?* Emergency Contact*Name:Telephone:Relationship: Notice of Intent to Verify Background Information* I AgreeIn connection with my application for volunteering with Tu Nidito, I understand that a consumer report may be requested to verify my identity through my social security number. I also understand that you will be requesting information concerning my motor vehicle operation history and criminal history from various states of residency, private and insurance sources along with other public records available.Confidentiality Statement* I AgreeI acknowledge that Tu Nidito Children and Family Services is an agency whose purpose is to provide support to children and their families as they deal with serious illnesses and/or death. I hereby agree to follow the strictest of ethics when trusted with confidential information. This confidential information includes but is not limited to: the identities of Tu Nidito participants, files pertaining to families, information concerning the organization, volunteers and/or staff, and information received from interviews, one on one visits, support groups, or special events.Media Release I AgreeI authorize Tu Nidito Children and Family Services to use my photograph, name and/or information about me regarding my volunteer service providing support to children and their families as they deal with serious illnesses and death. I understand that media may include but is not limited to newspaper articles, television, radio, film documentaries, and speaking engagements. Tu Nidito Volunteer Waiver and Release* I AgreeWAIVER AND RELEASE: I hereby release and forever discharge and hold harmless Tu Nidito Children and Family Services, its officers, directors, agents, volunteers and employees, and their respective successors and assigns (collectively, "Tu Nidito") from any and all liability, claims, demands and causes of action, of whatever kind or nature, either in law or equity, which may hereafter arise from my volunteer work and participation with Tu Nidito, including transportation to and from Tu Nidito. I understand and acknowledge that this Release discharges Tu Nidito from any liability or claim that I may have against Tu Nidito with respect to any bodily or other injury, illness, death, or property damage that may result from my volunteer work and participation with Tu Nidito, including transportation to and from Tu Nidito. I also understand that Tu Nidito does not assume any responsibility or obligation to provide financial or other assistance, including, but not limited to, medical, health, or disability insurance, in the event of injury, illness, death, or property damage. ASSUMPTION OF RISKS. I understand that occasionally accidents occur and that participants may sustain serious personal injury as a consequence thereof. Knowing the risks, nevertheless, I am volunteering for Tu Nidito and freely accept and fully assume all such risks and dangers and the possibility of personal injury, death or property damage and loss resulting from any cause whatsoever, whether such risks are caused by the negligence of Tu Nidito or otherwise. Further, I acknowledge that Tu Nidito accepts no responsibility for the loss, damage or theft of personal property. OTHER. The laws of the state of Arizona will govern this Release. This Release is intended to be as broad and inclusive as permitted by Arizona law. If any portion is held invalid, the balance will continue in full legal force and effect. This Release is binding on and inures to the benefit of the parties and their respective successors and assigns. I have read this agreement, fully understand its terms, have signed it freely and voluntarily, and intend my signature to be a complete and unconditional release of all liability to the greatest extent allowed by law. Covid-19 Guidance, Subject to ChangeIndividuals identified as Close Contacts to a COVID positive person are divided into two groups: 1. Those who have been boosted OR who have completed the primary series of Pfizer or Moderna vaccine within the past six months OR who have completed the primary series of J&J vaccine within the past 2 months. 2. Those who have completed the primary series of the Pfizer or Moderna vaccine more than 6 months ago and are not boosted OR who have completed the primary series of J&J over 2 months ago and are not boosted OR who are unvaccinated. Exposure to COVID-19: Fully vaccinated individuals, with a booster, who are identified as a Close Contact to a COVID positive person: Do not need to quarantine, but you will be required to wear a mask while at Tu Nidito and should test on day 5 from initial contact. Individuals identified as a Close Contact to a COVID positive person who are unvaccinated OR individuals who are beyond 6 months from completing the primary series of Pfizer or Moderna OR individuals who are beyond 2 months from completing the primary series of J&J: Must quarantine for 5 days, wear a mask while at Tu Nidito and should test on day 5 from initial contact. Testing Positive for COVID-19: All Individuals: Isolate for 5 days; then: No symptoms: Return to normal activities and wear a mask at Tu Nidito. Symptoms after 5 days: Stay home until you have no fever for 24 hours; wear a mask at Tu Nidito. No Symptoms after 5 days: Return to normal activities and wear a mask at Tu Nidito. It is Tu Nidito's policy that all individuals on Tu Nidito property wear a mask at all times. I have read Tu Nidito's Covid-19 Guidance Consent* I AgreeI have completed and reviewed this entire form and attest that the information provided is true. I also grant permission for Tu Nidito to obtain information from my references and/or other volunteer organizations with which I have worked that may be pertinent to my application.Applicant Signature* Reset signature Signature locked. Reset to sign again For volunteers under 18, a parent or legal guardian’s signature is required below. Reset signature Signature locked. Reset to sign again This is to certify that I, as parent/legal guardian with legal responsibility of the volunteer whose name appears above, do consent and agree to the terms and conditions described above and included in volunteer training materials and Policy & Procedure Manuals. I further acknowledge that a copy of these materials may be requested by me at any time.
