ISHINE 5T VOLUNTEER

VOLUNTEER AT i-SHINE

PHOTO*

No File Chosen

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Name*

First Name

Last Name

Current School*

Current Grade*

Cell*

Email*

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Parent Name*

First Name

Last Name

Parent Email*

What organization have you worked or volunteered in?

When? For how long?

Please include complete duration of dates you volunteered there.

Please also provide us with contact information of a reference person from your volunteer experience.

VOLUNTEER EXPERIENCE I*

Reference I Name*

First Name

Last Name

Reference Email*

VOLUNTEER EXPERIENCE II*

Reference II Name*

First Name

Last Name

Reference II Email*

AVAILABILITY

i-Shine runs Monday and Wednesdays throughout the academic year from 3:45-6:40pm.

Please state the day and time that you are you available to volunteer at i-shine.

DAY(S)*

MONDAY WEDNESDAY

What time(s)?*

What special skills, talents , languages fluency or interests do you have, that can add to our program?*

Where have you spent your summers?*

Do you have any severe allergies or medical information that we should be aware of?*

Emergency Contact*

First Name

Last Name

Phone*

Relationship*

We are always looking for new i-Shine activities, please come to your interview with an idea for an activity that you and a group of friends would be willing and able to run at the program.

AGREEMENT

I have truthfully completed this application. I will honor the time commitment required for my volunteer assignment and will adhere to all policies and procedures outlined in any materials provided by Chai Lifeline.

Agreement of confidentiality

As an i-Shine volunteer, I understand that in the course of my work with this program, I might learn privileged and confidential information about the children and their families, including, but not limited to medical conditions and treatment, finances, living arrangements, employment, and/or relationships among family members. I understand that all such information must be treated as confidential. I agree to disclose any information learned about patients and their family members only to one of the adult coordinators of the program. I understand unauthorized disclosures are considered grounds for immediate termination of volunteer status.

We have a "no cell phone" policy at i-shine. You will be asked to leave your phone in a secure box throughout the i-shine sessions. Please sign here if you agree to these terms. If you do not agree to these conditions we can not accept your application.

YOUR INITIALS (AS DIGITAL SIGNATURE)