BEFORE FILLING OUT AND SUBMITTING THIS FORM, PLEASE READ THE VOLUNTEER ORIENTATION MATERIALS AVAILABLE AT THIS LINK

North Helpline Lake City/Northgate Volunteer Application Form

First Name Middle Name Last Name

Address City Zip

Phone email birth date

Would you like to receive our newsletter?      by email            paper format            both            none

What is your current occupation?

What skills or training do you have?

When are you available? Choose all that apply

What areas would you be interested in working? Choose all that apply

Are you volunteering to fulfill an obligation?

for School? if so, indicate the school

for Court? if so, indicate the court

Explain

for something else? if so, indicate

Are you volunteering with a group? for example, a church group, workplace group, service club [Lions, Scouts, Seattle Works]

If so, indicate the group

Emergency contact name relationship phone

Orientation Statement: I agree that I have read the North Helpline orientation materials. I understand all of the materials provided, including the Volunteer Code of Conduct section, how to become eligible for food distributuion information and the volunteer Safety Requirements. These items are available at the link at the beginning of this form. A paper copy is available in the foodbank office.

Confidentiality Statement: As a condition of my volunteer service which may concern clients who have received services from North Helpline Programs, I agree not to divulge any information obtained in the course of such activity to unauthorized persons and not to publish or otherwise make public any information regarding clients who have received service. I recognize that unauthorized release of confidential information may make me subject to a civil action under Washington State Law.

By marking this box I signify my agreement with both the Orientation Statement and the Confidentiality Statement.

Thank you for your application. The Volunteer Coordinator will contact you for scheduling.