Youth Profile/Waiver Weekend

Before registering for a project, all youth volunteers MUST first complete a 2019-2020 Youth Volunteer Profile and Waiver. A youth who attends a YVC project without a waiver will not be permitted to serve. Volunteers only need to complete one waiver, regardless of the number of projects they are signed up for. If you sign up multiple volunteers, you will need to complete a waiver for each volunteer. You DO NOT need to fill out another profile/waiver form if you have already completed on this year.

I have already completed a waiver for the 2019- 2020 program year.

Youth Volunteer Profile and Waiver

THIS IS A LEGAL DOCUMENT. PLEASE READ CAREFULLY.
Please note, this information is kept confidential and is collected for anonymous grant reporting and program improvement purposes only.

For Volunteers:

* Indicates required field

Name *

First

Last

First Name Last Name

Gender *

Male Female Prefer to self-describe

If you chose 'Prefer to self-describe' and would like to specify, please do so below: *

Date of Birth (MM/DD/YYYY) *

Age *

Grade *

Youth may specify here *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Youth's Phone Number *

Youth's Email *

School *

*If you chose 'Other' please specify here *

Why are you/your youth volunteering? *

Youth Volunteer Shirt Size *

For Parents/Guardians:

Parent/Guardian Name *

First

Last

Parent/Guardian Email *

Parent/Guardian Phone Number *

Emergency Contact #1 (if we cannot reach you) *

First

Last

Parent/Guardian Alternate Phone *

Emerg. Contact #1 Phone Number *

Emergency Contact #2 (if we cannot reach #1) *

First

Last

Health Care Provider/Family Physician *

First

Last

Emerg. Contact #2 Phone Number *

Health Care/Family Physician Phone Number *

Does your child have any allergies? *

Yes No

If you chose 'Yes' please explain: *

Is your child currently under medical care? *

Yes No

If you chose 'Yes' please explain: *

Please list any mental or physical condition(s) your child has we should be aware of and any medication they are taking *

Please provide any additional information necessary for program directors to provide a safe experience for your youth volunteer: (For example: food allergies, who can/cannot provide transportation to youth, etc.) *

This information assists us in receiving funding to cover scholarships. This information is kept CONFIDENTIAL.

Qualifies for free or reduced school lunch, or enrolled in a school where the majority of students are eligible for free or reduced lunch
Completing court-ordered service or is a former juvenile offender
Living with a disability
Not currently enrolled in school
At risk to leave high school without graduating
In or aging out of foster care
Has limited English proficiency
Homeless or has run away from home

If the youth named above meets any of the following criteria, check this box *

My child meets one or more of the following criteria

Risk Disclosure: I understand that adult supervisors will accompany my child on all projects and activities. I also understand that the supervisors may be volunteers and that the project or activity will involve the normal level of risk associated with such a project or activity. I agree that this form shall waive any rights, claims of responsibility or liability, or cause of action resulting from personal injury to my child in the YVC program and agree to indemnify the partner agency and its employees or representatives from any such claims.

Medical Care Authorization: At any time due to such circumstances as accident or sudden illness I hereby give permission for emergency medical treatment to be obtained for my child. I understand that a YVC representative or the partner agency will call me prior to leaving or upon arrival at the emergency destination, and that I will be responsible for all related expenses incurred (i.e. ambulance or taxi costs, etc.).

Photographic/Transportation Release: In the event my child is photographed or filmed for promotional purposes while participating in a YVC project, the photo or video may be used by YVC or any of its related agencies for promotional purposes. I authorize YVC and/or partner agency staff to transport my child in their vehicles if needed.

Parent/Legal Guardian Responsibility: I will inform YVC of any special need or condition my child has. I understand withholding this information is unfair to my child and to the YVC leader entrusted with my child's safety. I will be punctual when dropping off/picking up my child from projects, both for his/her safety and as a courtesy to YVC and its partner agencies. I understand that violating these policies may lead to my child's exclusion from YVC programs.

Youth Agreement
Youth volunteer agrees:

To be on time and work all scheduled project hours OR notify YVC in advance if you cannot.
To maintain a positive attitude and show respect to everyone at the project.
To attend any required orientation and training and to participate in all project activities, including games.
To abstain from profanity, drugs, tobacco, alcohol, sexual activity or violence of any form on projects.
To keep all personal electronic devices off and out of sight during YVC activities.

YVC agrees:

To treat the youth volunteer with respect.
To provide the youth volunteer with appropriate duties that match his or her experience and interests when possible.
To provide trained, screened adult team leaders to guide and assist the youth volunteer on projects.
To provide orientation, training, and evaluation for the youth volunteer as needed.
To recognize the efforts of the youth volunteer and provide confirmation of service hours upon request.

I agree to the terms and conditions *

Yes

By checking the box you acknowledge that you have read and understand this waiver, agree to its provisions, affirm that you are the parent/legal guardian of the child named above, and verify all the information you have given is correct.

Submit

2019-2020 Youth Volunteer ​Profile and Waiver.

Youth Volunteer Profile and Waiver

For Parents/Guardians:

Address

Telephone

Email

2019-2020 Youth Volunteer Profile and Waiver.