Volunteer Registration

Name

First

Last

Email address*

Preferred Phone*

Address Line 1*

Address Line 2

City

Zip Code

State

Florida resident?*

Full Time

Part Time

Preferred Language Spoken*

Other Languages Spoken*

What is your date of birth?

What is your gender?*

Female

Male

Other/prefer not to say

Current Employment Status*

Full Time

Part Time

Self-employed

Retired

Occupation (current or former)*

Have you ever been convicted of a felony?*

Yes

No

Your Preferences

List your preference for tutoring

Day(s)

Time

Do you belong to any groups or clubs? (e.g., book club, tennis group)

Please share any additional information about yourself that may be relevant to working with LVCC, including prior experience.

Character References

LVCC requests you provide three character references we can contact before we match you with a student.

Character Reference #1: Name*

First

Last

Character Reference #1: Phone*

Character Reference #1: Email *

Character Reference #2: Name*

First

Last

Character Reference #2: Phone*

Character Reference #2: Email *

Character Reference #3: Name*

First

Last

Character Reference #3: Phone*

Character Reference #3: Email *

CONFIDENTIALITY

Never give out personal information about a tutor, student, or volunteer.
Refer any request of information relating to LVCC tutors, students, or volunteers to the appropriate staff.
Personal information about a tutor, student, or volunteer should only be shared on a need to know basis.

As a tutor/student/volunteer for LVCC, 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 LVCC 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 LVCC.

INITIALS

PERSONAL RELEASE AGREEMENT

For good and valuable consideration, receipt of which is hereby acknowledge, I irrevocably grant to Literacy Volunteers of Collier County and it assigns, licensees and successors, the right to use my image and name in all forms and all media including composite or modified representation of 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 not obligated to utilize any of the rights granted in 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

RELEASE OF LIABILITY

FOR GOOD AND VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, the undersigned does hereby release LVCC, 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 LVCC 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.

INITIALS

First and Last Name*

First and Last Name

Date*

Date

Signature*

Signature

Are you human?*

Thank you for your interest in volunteering or tutoring with LVCC!

Character References

CONFIDENTIALITY

PERSONAL RELEASE AGREEMENT

RELEASE OF LIABILITY