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Waiver
By filling out this form, you are helping us keep track of the number of unique volunteers, volunteer groups, and more. Your contact information is kept confidential and not shared with anyone outside the Open Doors staff and Board of Directors. If you have questions about how your information is used, please don’t hesitate to call our office. We ask that each volunteer fill out a form at the beginning of each shelter season.
I agree not to divulge, publish, or otherwise make known any identifiable personal information which is obtained in the course of my service as an Open Doors volunteer. Confidential information includes any data or information that identifies a guest or his/her family (i.e. full name, address, phone number, SSN, etc.); in-take forms, assessments, referral forms, computer records and information received verbally from the guest. I understand that the guest’s written authorization is required for me to disclose any such information to any party outside the Open Doors staff, and that this authorization must be obtained by first discussing the situation with the Executive Director.
I understand that should I have concerns about a situation that I feel I must share; I may speak with a Shelter Staff Member or the Executive Director without breaching my agreement to confidentiality. I further understand that the law may require me, under certain circumstances, to report information to either Adult Protective Services or to Child Protective Services and that such a report would not be a violation of this confidentiality agreement.
I recognize that unauthorized release of confidential information may result in legal penalties including possible fines or lawsuits by a guest or guest’s family. I understand and agree to the above policy, and I am aware that a breach of confidentiality will be grounds for dismissal in my role as a volunteer for Open Doors.
I give Open Doors permission to use, reproduce, print and/or publish my likeness, through video, photographs, and/or audio recordings, to be used solely for the purpose of Open Doors promotional material and publications. I waive any rights of compensation, liability, furthermore, the right to prior review of any material.
COVID-19 Notification: I agree to notify Open Doors Administrative Staff if I have been tested for COVID-19 at any time during the 72 hour period after I have volunteered at the shelter. Open Doors staff will also notify any volunteers of a possible exposure if a guest, staff, or another volunteer have been tested within 72 hours of a volunteers shelter visit. It is important that all volunteers adhere to CDC guidelines for mask wearing, hand sanitizing, and social distancing while at the shelter.
By filling out this form, you are helping us keep track of the number of unique volunteers, volunteer groups, and more. Your contact information is kept confidential and not shared with anyone outside the Open Doors staff and Board of Directors. If you have questions about how your information is used, please don’t hesitate to call our office. We ask that each volunteer fill out a form at the beginning of each shelter season.
I agree not to divulge, publish, or otherwise make known any identifiable personal information which is obtained in the course of my service as an Open Doors volunteer. Confidential information includes any data or information that identifies a guest or his/her family (i.e. full name, address, phone number, SSN, etc.); in-take forms, assessments, referral forms, computer records and information received verbally from the guest. I understand that the guest’s written authorization is required for me to disclose any such information to any party outside the Open Doors staff, and that this authorization must be obtained by first discussing the situation with the Executive Director.
I understand that should I have concerns about a situation that I feel I must share; I may speak with a Shelter Staff Member or the Executive Director without breaching my agreement to confidentiality. I further understand that the law may require me, under certain circumstances, to report information to either Adult Protective Services or to Child Protective Services and that such a report would not be a violation of this confidentiality agreement.
I recognize that unauthorized release of confidential information may result in legal penalties including possible fines or lawsuits by a guest or guest’s family. I understand and agree to the above policy, and I am aware that a breach of confidentiality will be grounds for dismissal in my role as a volunteer for Open Doors.
I give Open Doors permission to use, reproduce, print and/or publish my likeness, through video, photographs, and/or audio recordings, to be used solely for the purpose of Open Doors promotional material and publications. I waive any rights of compensation, liability, furthermore, the right to prior review of any material.
COVID-19 Notification: I agree to notify Open Doors Administrative Staff if I have been tested for COVID-19 at any time during the 72 hour period after I have volunteered at the shelter. Open Doors staff will also notify any volunteers of a possible exposure if a guest, staff, or another volunteer have been tested within 72 hours of a volunteers shelter visit. It is important that all volunteers adhere to CDC guidelines for mask wearing, hand sanitizing, and social distancing while at the shelter.
Check here to show you accept the terms stated above for yourself.
