Volunteer Registration Form

Volunteer Registration Form

At Bobby Dodd Institute, we believe in the power of volunteerism to transform lives. By joining our volunteer program, you have the opportunity to contribute your time, skills, and compassion to support individuals with disabilities in reaching their fullest potential.

Note: Volunteers are required to undergo an organizational background check.

CONFIDENTIALITY STATEMENT

It is the policy of BDI to ensure the confidentiality of the individuals we serve in compliance with HIPAA and other federal and state laws regarding Confidentiality and Privacy Practices. Any information entered on this form may not be shared with another person or agency without your prior knowledge and written consent.

PERSONAL INFORMATION

Help us plan for your volunteer day by telling us more about yourself.

Full Legal Name*

First M. Last

Preferred First Name

The first name you go by, if different from your legal first name

Date of Birth*

For emergencies - medical facilities use D.O.B. as a form of identification

Mailing Address*

123 My Street

Atlanta, GA 12345

Cell Number*

Text-capable number where you can be reached the day you volunteer. By providing your cell number, you consent to receive text messages from BDI. BDI will not give your phone number to any third party without your express permission.

Phone

Email Address*

BDI will send important details about your volunteer day to this email. By providing your email address, you consent to receive email communications from BDI. BDI will not give your email address to any third party without your express permission.

Will you be volunteering individually or with a company?*

Individually

In a group from my company

T-shirt Size

Sizes are standard U.S. adult t-shirt sizes

Select

Company Contact

Name of person from your company organizing your BDI volunteer group. If unknown, leave blank.

Company Name*

Area of Interest*

Serving in the Warehouse - Packing and Labeling

Select

Personal Interests*

Tell us a little about your interests, passions, and hobbies. Additionally, if you have a specific volunteer project in mind, please tell us about it here. We'll try to provide opportunities that suit your interests!

Availability to Volunteer

Kindly highlight the days of the week and time that you are available to volunteer.

How did you learn about BDI?*

Please select from the options below. If you learned about BDI through a source not listed, please type in the source name/type.

Select or enter value

EXPERIENCE WITH DISABILITIES

The following questions help us understand what prior knowledge you have about people with disabilities so that we can provide an appropriate level of disability awareness training.

Disability Status*

Do you have a documented disability?

Yes

Prefer not to disclose

Family Members with a Disability*

Do any of your family members or close friends have a disability?

Select

Prior Interaction with the Disability Community*

No prior interaction

Some prior interaction

Lots of prior interaction

Background Check

Our activities requires having a background check done. Do you agree to this?

Select

EMERGENCY CONTACT INFORMATION

Please provide information for the individual you would like for us to contact in the unlikely event of an emergency.

Emergency Contact Name*

First M. Last

Emergency Contact Phone Number*

Phone

Emergency Contact Relation*

Your relationship to/with your emergency contact

DISCLOSURES & AGREEMENTS

BDI promises to offer prompt and courteous services to you, the volunteer, which will include (among other things) a clearly defined volunteer opportunity with the presence of a paid staff member at each occurrence and a safe and clean environment for volunteer service with access to phones, restrooms, and water cooler. Furthermore, BDI promises to provide you with opportunities to grow and expand according to your abilities and interests in furthering the mission of BDI.

By checking the box below, you consent to appear in BDI media materials, certifying that:

I have been advised that the purpose of the

materials in which I will appear will be used to promote Bobby Dodd Institute (BDI), a nonprofit organization, and its mission.

I understand and give consent that photography, video, and/or other images of my likeness may be made by BDI or as authorized by BDI on the day I volunteer. I give consent that the photos and images may be used by BDI in marketing materials, including but not limited to videos; newsletters; printed materials; scrapbooks; BDI website and/or BDI social media, including Facebook, Twitter, LinkedIn, and/or Instagram, to promote Bobby Dodd Institute’s mission and programs until such a time as I withdraw my consent.

I understand that editorial copy and/or narration may accompany the photographs. I further understand and consent that this copy may identify me by name. I hereby waive any right to inspect and/or approve the use, image, or copy that may accompany my image, or any finished product that includes my photo or likeness.

I consent to the use of my likeness by BDI for the above-stated

purpose(s), and release BDI, agents, and employees from all liability related to the production of such materials.

I consent to the use of my likeness by BDI.*

In turn, by checking the box below, you agree to ALL of the following:

As a part of my volunteer/community service work for BDI, a nonprofit organization, I hereby accept sole responsibility for any injury that I may incur during the time in which I am working as a volunteer for BDI. I further hereby release BDI, its officers and directors, employees, volunteers, and agents from any and all claims or cause of action arising from any accident or injury I may suffer during the time in which I am volunteering. I hereby attest that my attendance at and involvement with BDI is voluntary, that I am participating at my own risk and that I have read the foregoing terms and conditions of this release.

I hereby confirm, represent and warrant that I have never been convicted of, charged with or am subject to possible pending charges of a violent crime, including child abuse or neglect, kidnapping, rape or any sexual offense, nor have I ever been ordered by a court to receive psychiatric or psychological treatment in connection therewith.

Pursuant to Georgia State Law, BDI requires a criminal background records check for volunteers working independently with any clients. Checking the box below and electronically signing this volunteer registration form, constitutes the following statement: "I do hereby authorize BDI or its authorized agents to search and review any criminal history and/or traffic charge record including any records of complaint, arrest, trials and/or convictions concerning myself."

I understand that if I plan to participate in volunteer opportunities that require transporting clients, BDI will check my driving record, as well as personal and/or professional references.

I understand as part of my commitment that I will attend volunteer training commensurate with my duties and that I will be expected to keep a record of my volunteer hours.

I recognize the right of BDI to terminate, without notification as to reason for termination, the services of any volunteer at any time.

I agree to the above terms and conditions.*

ACKNOWLEDGEMENT AND SIGNATURE

I understand that providing my full legal name with today's date constitutes a legal signature confirming that I acknowledge and warrant the truthfulness of the information provided in this document.

I acknowledge my name & date (below) as my legal signature.*

Signature*

Please type your full legal name below.

DISCLAIMER: By typing your name below, you are signing this form electronically. You agree that your electronic signature is the legal equivalent of your physical signature on a print document.

DISCLOSURES & AGREEMENTS*

Type in today's date (MM/DD/YYYY)

Send me a copy of my responses

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