Karsh Center Special Volunteer Projects: COVID-19 Community Relief Volunteers
Thank you very much for your interest in supporting the Karsh Center's efforts to feed and care for our neighbors during this time. To best keep our very vulnerable client population as well as our volunteers safe, each individual interested in volunteering must fill out the form below. Our volunteer activities at this time are limited, so as to keep contact among individuals as low as possible. If you would like to help as a family unit, couple, or with a friend, this form must still be completed for each individual. This application has four sections: 1) basic profile and contact information, 2) health and wellness verification, 3) volunteer interests and capacity, 4) Karsh Center volunteer agreement and waiver. After you submit this form, our team will be in touch about next steps as volunteers are needed. Thank you for your patience, and desire to serve our neighbors during this time of great need. If you have any questions, please reach out to firstname.lastname@example.org.
Cell phone number
Street Address Line 2
State / Province
Postal / Zip Code
Antigua and Barbuda
Bosnia and Herzegovina
Central African Republic
Cocos (Keeling) Islands
Democratic Republic of the Congo
Turkish Republic of Northern Cyprus
Papua New Guinea
Republic of the Congo
Saint Kitts and Nevis
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Sao Tome and Principe
Trinidad and Tobago
Tristan da Cunha
Turks and Caicos Islands
United Arab Emirates
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Emergency Contact Name
Emergency Contact Phone Number
Have you volunteered with the Karsh Center before?
Are you a Wilshire Boulevard Temple member?
How did you learn about the Karsh Center?
Volunteer Health & Wellness Verification
As of this date, are you feeling healthy?
As of this date, have you personally traveled in the last two weeks to a Warning Level 3 or Alert Level 2 country OR are you in close contact/living with someone who has traveled to a Warning Level 3 or Alert Level 2 country? For more information, copy/paste this link into your browser: https://www.cdc.gov/coronavirus/2019-ncov/travelers/after-travel-precautions.html
Have you tested positive or are you awaiting test results for COVID-19?
Are you living with or had close contact with anyone who is awaiting testing for COVID-19, or has tested positive for COVID-19?
Do you or anyone you live with have any health conditions that place you in a higher risk group for COVID-19? Click this link to learn more: https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/high-risk-complications.html
Have you been practicing social distancing since at least March 11? For more about what this means, copy/paste this link into your browser: https://www.npr.org/sections/health-shots/2020/03/17/817251610/its-time-to-get-serious-about-social-distancing-here-s-how
Do you agree that you will notify the Karsh Center Volunteer Engagement team prior to a volunteer shift if any of the above answers change from the time that you filled out this application?
Volunteer Interest & Capacity
The Karsh Center is working to stay flexible in an effort to best respond to client and community need. Below are some possible volunteer activities that either are currently happening or may be launched in the near-future. All on-site volunteer activities will take place with a very limited number of volunteers in one space, per the most recent CDC recommendations. All on-site volunteers will be required to wash their hands regularly, wear gloves, and for certain activities, wear a mask. Additionally, the Karsh Center facility will undergo sanitation and cleaning multiple times per day, including between volunteers who are signed up for different shifts.
Which of the following are you interested in?
Remote volunteering - something I can do from my home
On-site volunteering - in isolation (ex: preparing supplies in a space without others)
On-site volunteering - client services (ex: assisting with handing off supplies to clients who come to receive essentials, maintaining proper social distance and CDC guidelines around number of people in one space)
Driving: pick-ups and deliveries of food and essential items
Outreach and communication
Donate essential supplies
Do you speak any of the following languages fluently?
Please select which of the following are true for you:
I have access to a phone, and am interested in doing phone outreach to Karsh Center clients and community organizations.
I have a computer, and am interested in doing virtual outreach to Karsh Center clients and community organizations.
I have a car and/or will drive the Karsh Van, and am interested in assisting with distributing and/or dropping off essential items (such as groceries, diapers, or hygiene items) to Karsh Center clients and/or community organizations
I would like to organize a drive/assemble bulk items for hygiene kits (new socks, toothbrushes, toothpaste, soap, shampoo/conditioner, lotion, deodorant, razors, shaving cream, hand sanitizer, wipes, tissues)
I am interested in volunteering at the Karsh Center, and/or any other Karsh Center Collaborators or community organizations that may be in need of volunteer support at this time
Are there any other ideas you have or ways you would like to contribute as a volunteer?
Karsh Center Volunteer Agreement & Waiver
Please review the Karsh Center's waiver, linked below and required of all individuals who volunteer with Karsh Center programs and services. E-signature must be provided by the individual volunteer. For volunteers younger than 18 years old, parent or legal guardian must e-sign on their behalf.
Name of individual signing waiver (for anyone under 18 years old, this should be a parent or legal guardian. 18 and older this should be the name of the applicant themself)
Volunteer Agreement & Waiver Signature (use mouse/cursor to write out signature)
Karsh Center Volunteer Photo Release
Please review the Karsh Center's photo release, linked below. E-signature should be completed by the individual applicant, except for volunteers younger than 18 years old, for whom parent or legal guardian must e-sign on their behalf.
Name of individual signing photo and video release form (for anyone under 18 years old, this should be a parent or legal guardian. 18 and older this should be the name of the applicant themself)
Photograph & Video Release Signature (use mouse/cursor to write out signature)
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