Volunteer Application

Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Email*
Home Telephone Number
Mobile Telephone Number*
Date of Birth*
Emergency Contact
Name*
First Last
Phone*
Relationship*
Are you a U.S. citizen, or are you otherwise authorized to work in the U.S. without any restriction?*
- Yes
- No
What days would you be available to volunteer at Wellspring?*
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- No preference
- AM
- PM
Special skills or talents you would like to share:
Please let us know if you would like to serve in other capacities such as fund raising, shopping, donating supplies, etc.*
Are you available to make deliveries?*
- Yes
- No
Most deliveries are made Mon-Fri between 9am and 3pm
References*
First and Last Name Street Address City/State/Zip Phone Number Number of years Known
Education Information
Please enter any education information in the following format: Institution/Type of Degree/Graduation Date/Area of Study
Other training, certifications or licenses held?
Our jobs often require physical activity from our staff and volunteers. This may mean assisting a participant in some physical way or participating in a physical activity with our participants such as water sports, walking, other sports, etc. Are you restricted from participating in any physical activity?*
- Yes
- No
Media Consent*
I agree
Wellspring Community has created media outlets for purposes of public relations, promotions and parent/guardian communications. The media outlets include; but are not limited to website, blog spot, video, photographic materials, print and/or other electronic means. The media outlets may include pictures of our program activities to include participants, volunteers and other staff members. It may also include written language which may describe events taking place during program hours, news and updates and may include specific information about participants, volunteers and staff members. The information contained within the media outlets may change daily. Wellspring Community will not include last names, ages, address or telephone numbers in any of its outlets. Please review the preferences below, make your selection and sign where indicated. Payments are not made for items published. I will allow my photograph, program work or written language describing my participation during a Wellspring Community program to be published on any Wellspring Community outlet.
Wellspring Community currently communicates via emails to all volunteers in the event of an emergency, or inclement weather that results in a delayed start, early dismissal or closure. If you would like to be communicated via text messaging as well as emails, please sign below and fill in your cell phone number and cell phone provider. Please note that message and data rates may apply.
- Please check here if you would like to receive text messages about volunteer opportunities and updates as well.
Please list the cell phone number and cell phone provider you use.
Electronic Signature*

Enter your name. This serves as your electronic signature.
I attest that the information provided within this application is accurate to the best of my knowledge. I have read and understand Wellspring Community's God-centered mission, vision and value statement and I agree to support this with both conduct and speech. **
I agree attest
Release of Liability
I recognize that, as a volunteer, I represent Wellspring Community to the public. I accept the responsibility for this status and will conduct myself in a professional manner. I will be clean and sober when conducting business as a representative of this organization.*
Yes
I agree to maintain the confidentiality of all volunteers, clients, and donors about whom I have personal and identifying information.*
Yes
I agree to honor the commitment length and frequency of service that I make to the organization. I agree to provide as much advance notice as is possible in the event that I will be absent from my shift. I agree to update my personal information and emergency information as changes occur.*
Yes
I am aware that as a volunteer member, I expose myself to potential hazards which include but are not limited to: kitchen accidents, cuts, burns, back injury from lifting, swimming accidents, pool accidents, accidents from housekeeping chores, car accidents, property damage or injury to others in car accidents, falls, muggings, etc. Potential hazards have been explained to me. I am participating in this service with the knowledge of the potential hazards involved and hereby agree to accept any and all risks of injury.*
Yes
I agree that my assignees, heirs, distributes, guardians and other legal representatives will not make a claim against, or sue for injury or damage resulting from the negligence or other acts, howsoever caused, by any employee, agent, or volunteer contractor of the organization as a result of my participation as a volunteer. I hereby release Wellspring Community, its employees, board of directors and anyone else affiliated with them from all actions, claims, or demands that I, my assignees, heirs, guardians and legal representatives now have or may hereafter have for injury resulting from my participation as a volunteer.*
Yes
If my volunteer service position includes driving an automobile, I acknowledge that I have both a valid drivers license and automobile liability insurance policy as required by state law. I agree to maintain my license and insurance in good standing for my entire tenure as a volunteer or staff member for the organization. I am knowledgeable of and agree to abide by local and state traffic laws. I agree not to drive while under the influence of alcohol and/or other intoxicating substances.*
Yes
It is the responsibility of every staff member and volunteer to report any suspicion of abuse or neglect of any participant served by Wellspring Community to the program director. I will work to maintain an atmosphere of physical and emotional safety for everyone associated with the Wellspring program. I agree that I will not participate in any sort of harassment, exploitation, intimidation, physical, emotional or sexual abuse or neglect of any participant while working/volunteering for the Wellspring program.*
Yes
I have carefully read this agreement and fully understand its contents. I am aware that this is a release of liability and I sign it of my own free will. **

Please enter your electronic signature (Full Name). Thank you for volunteering with Wellspring!
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826 Park St. #200 Castle Rock, CO 80109

303-660-1935

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First and Last Name	Street Address	City/State/Zip	Phone Number	Number of years Known

Volunteer Application

Emergency Contact

Release of Liability