ReMerge Volunteer FormInterested in volunteering? Fill out this form and we will be in touch shortly! We can't wait to hear from you! Name * First Name Last Name Organization Name Other Names (Alias, Maiden Name, etc.) Email * Phone Number * Address Address 1 Address 2 City State/Province Zip/Postal Code Country Volunteer Type * Individual Group Work Type Select all of the areas you're interested in. GED Tutor Administrative Tasks Organization Fundraising Fitness/Wellness Mentorship Other Frequency Weekly Monthly Special Events Other Emergency Contact (Name, Relationship) Emergency Contact Phone Number (###) ### #### Child Safety * Are you aware of any traits or tendencies that you possess that could pose a threat to any children or youth? Yes No Criminal History * Excluding traffic related offenses, have you ever been accused or convicted of criminal activity, or entered a plea of guilty or no contest to a criminal offense of any kind? Yes No Abuse/Sexual Misconduct * Have you been accused or convicted of sexual misconduct, or entered a plea of guilty or no contest to abuse or sexual misconduct? Yes No Compensation * I acknowledge that I am volunteering my time and efforts for ReMerge, and that I will receive no monetary compensation or insurance. I understand Recordings * I grant ReMerge the right to make photo, video, and audio recordings of me ("Recordings") as well as the perpetual, world-wide right to record, re-record, copy, edit, reproduce, publicly display, perform and distribute the Recordings in any way consistent with ReMerge's mission, including use on the Internet. I waive the right to inspect or approve the finished product wherein the Recording appear. Yes Intellectual Property * Any work that I have created in my role/capacity as a volunteer for ReMerge in the past, present or future, recording in any form ("Creative Work") is for the exclusive ownership of ReMerge and is considered a "work made for hire" (defined in the US Copyright Act). If for any reason, the work related to my volunteer service for ReMerge is determined at any time not to be a "work made for hire," I agree to assign and do assign ReMerge all right, title and interest to the Creative Work. I understand Confidentiality * ReMerge wishes to maintain in confidence all information including current and former participants, marketing information, data, technology, commercial and research strategies, trade secrets, inventions and know-how disclosed by ReMerge to me, directly or indirectly, in written, oral or other tangible forms. In this regard, I agree that I will not disclose the confidential information and/or trade secrets with others without prior written consent of ReMerge, both during or after my volunteer service. I agree Liability and Compensation * As a volunteer at ReMerge I agree to abide by the policies and procedures. I understand that I will be volunteering at my own risk and that the organization, its employees and affiliates, cannot assume any responsibility for any liability for any accident, injury or health problem which may arise from any volunteer work I perform for the organization. I agree that all the work I do is on a volunteer basis and I am not eligible to receive any monetary payment or reward. I understand Verification * Please check your responses before submitting this form Yes No Date MM DD YYYY Thank you!We’re reviewing your information now!
