22-23 Volunteer Application

Volunteer Application

Thank you for your interest in volunteering with the Pomona Pride Center. We look forward to being in partnership and community with you. Please fill out the below form so that we can connect with you about opportunities that match your interest.
Chosen Name

Chosen NamePronouns
Legal Name*

First NameLast Name
The Pomona Pride Center is committed to affirming the name and pronouns of our community members and to transparency. For this reason, we feel it is important to share that the background process will require information that includes legal name.
Address

Street Address

Street Address Line 2

City/Zip CodeState

Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.
What Volunteer Class are you interested in?*

Tier 1Tier 2Tier 3Tier 4
Best Method of Contact

EmailPhone CallTextAny
Experience
Education Level

High School GraduateUndergraduate DegreeGraduate Degree
Do you have experience with children & youth?*

YesNo
Major/Minor Program of Study
Please describe in what capacity you have worked with children. (internships, jobs, volunteer work) *
Do you have a driver's license?

YesNo
Are you a registered sex offender?

YesNo
Resume (optional)

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Additional skills & knowledge (hobbies, skills, interests)

Certifications & Licenses

	Adult CPR	Infant/Child CPR	Basic First Aid	EMT/WFA/ WFR	Lifeguard Training/ WSI	LPN/ RN	LMFT/LPCC
Type

References

References (Please share the name of 3 people you've known at least a year.)

	Name	Relationship	Daytime Number	Evening Number
Reference 1
Reference 2
Reference 3

Agreements

ALL TIERS OF VOLUNTEERS, please read and select each as an indication that you agree to the following:
I agree to abide by the rules and regulations established by Pomona Pride Center in the interest of the health and welfare of youth, seniors and staff.I understand that unless PPC has received the satisfactory results of a criminal background screen (conducted with my consent) and I have participated in the minimum training required, I am not authorized to supervise youth, interact with youth without a staff member or board member present. I further understand that at no time is it acceptable for me to be alone with a youth and out of site and beyond hearing distance of a staff person.PPC sets the highest standards for youth and staff. I understand and agree that I am required to immediately report to the executive director any behavior that does not meet these standards. Unacceptable behaviors include, but are not limited to, sexual activity, drug or alcohol use, emotional concerns/issues, and physical concerns/issues among youth, staff, or between youth and staff. I understand that failure to report these behaviors may constitute personal negligence on my part and result in termination of my service.I understand that PPC is not responsible for, and therefore does not carry insurance to cover the repair or replacement of personal vehicles or personal property damaged or stolen during the course of my volunteer service, regardless of where and how the damage or theft may have occurred.In the event that my emergency contact cannot be reached and I am incapacitated, I hereby give permission to the Executive Director to secure treatment for me at the nearest health care facility.I agree and give consent to PPC to use films, videos, and/or photographs containing me or my likeness for brochures, advertisements, and/or any other publicity purpose.I further acknowledge and agree that I will adhere to all applicable safety rules, regulations, and provisions while participating in such activities as established by the Pomona Pride Center. I understand that failure to adhere to these rules, regulations, and provisions may result in immediate termination of my volunteer service with PPC.Tier 3 & 4: I authorize PPC to thoroughly investigate my educational background, past employment, and personal history that may relate in any way to my volunteer role. I will not hold any official PPC representative liable for giving or receiving information in this investigation.Tier 3 & 4: I understand and agree that I may be required to take a physical examination and test for illegal drug use as a condition of my volunteer service for the purpose of determining my abilities to perform duties now or in the future. I agree to consent to take such tests at such time as determined by PPC, and I release Pomona Pride Center and its’ representatives from any claims arising in connection with the use of information resulting from such an examination.
Acknowledgement

Please read and select each as an indication that you agree and acknowledge the following:
I acknowledge that I have read the above and I agree to all the terms listed. I certify that the statements made in this volunteer application are true and correct and have been given voluntarily.I recognize my right, as a volunteer, to discontinue my service at any time and for any reason. I also understand that Pomona Pride Center has the right to discontinue my volunteer service relationship.As a volunteer, I understand and agree that I shall not expect to receive any form of payment, including cash (wages) food, clothing, shelter or other kinds of payment, for volunteer talents and services I contribute to Pomona Pride Center.
Signature

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Volunteer Application

Experience

References

Agreements

Acknowledgement