I want to Volunteer!

Complete Your Registration Form for Volunteering and
Click “Submit” (bottom of form)
Form signing will occur at LVCC.

VOLUNTEER REGISTRATION
FIRST NAME *
MIDDLE INITIAL
LAST NAME *
GENDER MaleFemale
ADDRESS
CITY
STATE
ZIP CODE
HOME PHONE
CELL
EMERGENCY CONTACT
EMERGENCY PHONE
EMAIL *
PLACE OF BIRTH
DATE OF BIRTH
RESIDENT Full-TimePart-Time
MONTHS IN NAPLES
(For Part Time Residents)
FROM
TO
SECOND ADDRESS
CITY
STATE
ZIP CODE
EDUCATION High School DiplomaSome CollegeUndergraduate DegreeGraduate DegreeOther Education Experience
FIRST LANGUAGE
ADDITIONAL LANGUAGES
CURRENT EMPLOYMENT STATUS Full TimePart TimeRetired
OCCUPATION (Current / Former)
HAVE YOU EVER BEEN CONVICTED YesNo
Volunteering Dates

When are you available to Volunteer? (Be Specific)

MONDAY MorningAfternoonEvening
TUESDAY MorningAfternoonEvening
WEDNESDAY MorningAfternoonEvening
THURSDAY MorningAfternoonEvening
FRIDAY MorningAfternoonEvening
SATURDAY MorningAfternoonEvening
SUNDAY MorningAfternoonEvening
Do you have any special preference for volunteering?
VOLUNTEERING ROLES

What role would you prefer for volunteering?

Ambassador
Newsletter
Social Media
Fund Raising
Mailings
Special Events
Website/Internet
Marketing
Computer Lab
Workshop Assistance
Other (please specify)
CHARACTER REFERENCES
Please provide LVCC with three character references. We will contact your references prior to beginning your volunteering role.
FIRST REFERENCE
1st Reference NAME:
1st Reference ADDRESS:
1st Reference PHONE:
1st Reference E-MAIL (optional):
SECOND REFERENCE
2nd Reference NAME:
2nd Reference Address:
2nd Reference Phone:
2nd Reference E-Mail (optional):
THIRD REFERENCE
3rd Reference NAME:
3rd Reference Address:
3rd Reference Phone:
3rd Reference E-Mail (optional):
CONFIDENTIALITY

1. Never give out personal information about a tutor, student, or volunteer.
2. Refer any request of information relating to LVCC tutors, students, or volunteers to the appropriate staff member.
3. Personal information about a tutor, student, or volunteer should only be shared on a need to know basis.
As a tutor/student/volunteer for Literacy Volunteers of Collier County, I understand in the course of my service, I may learn information about students, tutors, volunteers, or staff which is confidential: e.g. finances, living arrangements. I understand all such information shall be treated as completely confidential even after I terminate my services with LVCC.
I agree not to disclose any information of a personal and /or confidential nature to any person not authorized by Literacy Volunteers of Collier County to have such information, without specific consent of the individual to whom such information pertains.
Failure to comply with this Confidentiality Agreement will result in release from affiliation with Literacy Volunteers of Collier County.

Initials: ________ Date: ____________

TUTOR STATEMENT OF INTENT
As a LVCC volunteer, I agree to do my best to carry out these volunteer responsibilities:
1. Begin or schedule volunteering within a month after completion of training.
2. Donate a minimum of a year to volunteering.
3. Maintain confidentiality.
4. Respect tutors' and students’ rights and understand their responsibilities.
5. When possible, attend in-service training workshops and roundtables.
If for some reason I am not going to be able to carry out my responsibilities as a LVCC volunteer, I will let the LVCC Office know and I will return the materials that were distributed to me, so that other volunteers can benefit from them. I have read and understand the responsibilities expected of me as a representative of Literacy Volunteers of Collier County.

Initials: __________Date: __________

PERSONAL RELEASE AGREEMENT
For good and valuable consideration, receipt of which is hereby acknowledged, I irrevocably grant to Literacy Volunteers of Collier County and its assigns, licensees and successors, the right to use my image and name in all forms and all media including composite or modified representations for all purposes, including advertising, trade or any commercial purposes throughout the world and in perpetuity. I waive the right to inspect or approve any versions of my image used for publication or the written copy that may be used in connection with said images.

I release Literacy Volunteers of Collier County and its assigns, licensees and successors from any claims that may arise regarding the use of my image including any claims of defamation, invasion of privacy, or infringement of moral rights, and/or rights of publicity or copyright. Literacy Volunteers of Collier County is permitted, although not obligated, to include my name as a credit in connection with said image. Literacy Volunteers of Collier County is not obligated to utilize any of the rights granted by this Agreement.

I have read and understand the terms of this Release and I am of the age of majority and am of sound mind.

Initials: _________ Date:_________________

RELEASE OF LIABILITY
FOR GOOD AND VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, the undersigned does hereby release Literacy Volunteers of Collier County, its licensees, successors, or assigns for any breach of said organization’s written or unwritten policies regarding performance of the undersigned’s duties as a literacy volunteer/tutor, or actions or activities made or performed by the undersigned while performing those duties as a literacy volunteer/tutor or ancillary thereto. It is the stated intention of the undersigned to fully RELEASE the Literacy Volunteers of Collier County to the fullest extent possible, from any and all liability which could arise as a result of the undersigned’s association with said organization, including but not limited to any legal actions, either criminal or civil, and agrees to indemnify and hold harmless the Literacy Volunteers of Collier County from any such liability. I have read and understand the terms of this Release and I am of the age of majority and am of sound mind.

Name:__________________________________________

Signature:_______________________________________ Date _____

TODAY"S DATE" *

*Your information will never be shared with any third party.