Volunteer Application

Thank You for Your Interest in Agape House of Prescott!

We are delighted that you are interested in volunteering for Agape House of Prescott. Many people who we serve are vulnerable individuals, so safety is very important. And, we need to learn more about you as you prepare to engage in a very rewarding volunteer opportunity and provide services to those in need.

Please take your time to review and complete the forms in this packet. The Agape House of Prescott Volunteer Handbook is also included with this application and will provide you with lots of information about our organization and services. Once you return the forms to our office, we will process them and get you scheduled for a volunteer orientation. If we learn of any concerns about your background check, we will contact you. If you have any questions, please ask!

We want you to become familiar with our culture and mission and, after you are confirmed as a volunteer, we encourage you to take advantage of the many varied volunteer opportunities that further the goals and ministry of Agape House of Prescott.

Our Mission:
Agape House of Prescott exists to provide long term transitional
housing for families who are without a residence. We actively seek to
keep the families together while helping facilitate additional support
services in order to equip the families for an independent and self-sustained future.

An independent functioning household is our goal. Dignity and self-respect are our aspirations. In short, we provide hope to families. Thank you for helping us deliver that hope.

Welcome to the Agape House of Prescott Volunteer Team.

Agape House of Prescott
New Volunteer Information Form

Step 1 of 6

STATEMENT OF FAITH

Agape House of Prescott is a 501(c)3 nonprofit organization, Christian founded and Christ-centered.
We believe the Bible to be the inspired, the only infallible, authoritative Word of God. (2
Timothy 3:16)
We believe that there is one God, eternally existent in three persons: Father, Son, and
Holy Spirit. (Matthew 28:19)
We believe in the deity of our Lord Jesus Christ, in His virgin birth, in His sinless life, in His
miracles, in His vicarious and atoning death through His shed blood, in His bodily
resurrection, in His ascension to the right hand of the Father, and in His personal return
in power and glory. (Luke 1:34-35)
We believe that for the salvation of lost and sinful people, regeneration by the Holy Spirit
is absolutely essential. (Eph 1:13-14)
We believe in the present ministry of the Holy Spirit by whose indwelling the Christian is
enabled to live a godly life. (Gal 5: 22-25)
We believe Jesus's word in John 14:6 "I am the way, the truth, and the life. No one comes to the Father except through Me."
We believe in the spiritual unity of believers in our Lord Jesus Christ. (Eph 4: 12-13)
We believe in recognizing the dignity of each person, caring and upholding them as
it to one of the least of these My brethren, you did it to Me."
I commit to not participate in divisive denominational controversies such as, but not
limited to, the following: day and type of worship, communion preparation and service,
creation theories, family roles or structure, grace vs. holiness living, baptism rituals and
traditions, gifts of the Holy Spirit, service order, dietary and cultural differences, end of
the world controversies, old vs. new covenant traditions, or political/ racial supremacy.
(2 Timothy 2:23)

Statement of Faith Acknowledgement(Required)

I agree with the statement of faith and uphold it's values.

I acknowledge the statement of faith and understand this is a 501c3 nonprofit Christian organization.

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Date of Birth(Required)

Email(Required)

Language(s) Spoken(Required)

Certificates Held(Required)

Emergency Contact & Phone Number(Required)

Please tell us about yourself(Required)

What church do you currently attend (if any), how long have you attended there, and what areas of service do you currently participate in?(Required)

Please share your testimoney of how you came to know the Lord and your current walk with Christ.(Required)

Please list professional skills, gifts, and/or areas of service that you would like to donate to Agape House.(Required)

Please list your availability (number of hours/days of the week you are available)(Required)

This original completed application along with background check will be filed securely in a locked office.
You may request a copy of all of the completed forms in this volunteer application. You also received an
Agape House Volunteer Handbook when you were given this Volunteer Application packet. Please read
the handbook within one week.

VOLUNTEER: I agree to read the Agape House Volunteer Handbook within one week of receiving it.

Signature of Volunteer(Required)

Date Signed(Required)

Agape House of Prescott
Assumption of Risk and Release from Liability

PLEASE READ CAREFULLY. THIS IS A LEGAL DOCUMENT THAT AFFECTS YOUR LEGAL
RIGHTS. IF YOU HAVE ANY QUESTIONS ABOUT THIS DOCUMENT, PLEASE CONTACT AN
ATTORNEY.

Name(Required)

First Last

1. PURPOSEAbove name individual requested to volunteer at Agape House of Prescott, 501(c)3 nonprofit organization, to participate without pay as a volunteer project located on their property.

2. ACCEPTANCE OF RISKI am aware that some projects may have HAZARDOUS ACTIVITY AND ENTAIL RISKS. I understand that any volunteer assignment that I agree to perform, even those that are not extremely physical in nature, has its risks. I am voluntarily participating in the activities and am accepting the risk. The hazardous activities may include (but are not limited to) the building, loading and unloading materials, painting, finishing, framing, carrying such materials to and from building sites, moving furniture, and other related activities. I understand the danger involved in such activities and participate with the knowledge that medical facilities are not available in the event I become ill or injured. Thus, I agree to accept any and all risks of injury, illness, or death, and verify this statement by placing my initials below:

Initials(Required)

3. RELEASE

In exchange for being permitted by Agape House of Prescott, to participate in volunteer activities and use of their tools and facilities, I agree that I, my heirs, personal representatives, and assigns, will not make a claim against Agape House of Prescott, or its directors, officers, agents, employees, volunteers, suppliers, contractors, subcontractors, or attorneys (the for injuries, illnesses or damages resulting from the negligent or intentional acts or omissions of the Released Parties. I release the Released Parties from all actions, claims, or demands that I, my heirs, personal representatives, or assigns now have or may have in the future for injuries, damages or death resulting from my participation in any Agape House of Prescott activities. I understand that my agreement to this Release will remain in effect throughout the entire time that I perform volunteer work for Agape House, unless I later revoke it in writing to the Agape House of Prescott Executive Director or I complete another Release on a later date.

4. INDEMNITY

I agree to indemnify and hold harmless the Released Parties from any and all loss, liability, to, in whole or in part, my participation as a volunteer in activities at Agape House of Prescott.

5. ADDITIONAL RELEASE

I transfer to Agape House of Prescott all right, title and interest I may have in any and all photographic images, video or audio recordings, interviews, and other written, visual or broadcast media made, originated or created by Agape House of Prescott or its agents or employees during or in connection with Agape House of Prescott volunteer program, including (but not limited to) any royalties, proceeds, or other benefits derived from such materials.

6. COMPREHENSION AND APPRECIATION

I have carefully read this Assumption of Risk and Release of Liability Agreement and I fully understand its contents. I am aware that this is a legal contract between Agape House of Prescott and me and that it affects my legal rights. I also understand that by releasing Agape House of Prescott from liability, I am giving up certain rights that I would otherwise retain. I acknowledge that I have had the opportunity to review this document and to seek legal advice if I have any questions, and I verify this statement by placing my initials below:

Initials(Required)

7. INSURANCE

I understand that Agape House of Prescott does not maintain health insurance
for work project volunteers.

8. INTENT OF AGREEMENT

I expressly agree that this Agreement is intended to be as broad and inclusive as permitted by the laws of the State ofArizona and that this Agreement shall be governed by and interpreted in accordance with the laws of the State of Arizona.

9. ARBITRATION

In the event of any claim or dispute relating to this Agreement or any of the activities or other matters described in the Agreement, I agree that such disputes shall be settled by binding arbitration in the City of Prescott, in accordance with the rules then prevailing of the American Arbitration Association, in lieu and instead of a jury trial. I verify this statement by placing my initials below:

Initials(Required)

10. ENTIRE AGREEMENT

This Agreement embodies the entire agreement and understanding between Agape House of Prescott and me. This agreement may not be changed, waived, discharged, or terminated unless agreed to in writing by Agape House of Prescott and me.

11. SEVERABILITY

I agree that in the event that any clause, sentence, or provision of this Agreement shall be held to be invalid by any court of competent jurisdiction, the validity of that clause or provision shall not otherwise affect the remaining provisions of this Agreement which shall continue to be enforceable. This Agreement is binding upon me and my heirs, personal representatives, and assigns, and any other person making a claim on my behalf. In addition, if I am a married person, I agree that this Agreement is made by me on my behalf and on behalf of the marital community of my spouse and me, and I agree that this Agreement will be binding on that marital community.

12. MINORS

Due to the potential hazards of some events, volunteers under the age of 18 years of age must be accompanied by an adult supervisor. Minors volunteering in non-hazardous areas must have this form and written authorization from a parent on file at Agape House prior to their volunteer event. Volunteer initial here:

Initials(Required)

Volunteer Agreement: I have read, understand, and agree to the terms of this document.

Signature of Volunteer(Required)

Date Signed

Signature of Parent or Guardian (if Volunteer is a Minor)(Required)

Date Signed(Required)

Agape House of Prescott
Conflict of Interest Disclosure Statement

This form must be completed by all employees, Board Members, and Volunteers in positions that may influence the actions of Agape House of Prescott.

Note: This statement of disclosure requires you to provide information about yourself and certain parties that are related to you. These following:

Your spouse, domestic partner, child, mother, father, brother or sister;
Any corporation or organization of which you are a board member, an officer, a partner, participate in management or are employed by, or are directly or indirectly, a debt holder or the beneficial owner of any class of equity securities; and
Any trust or other estate in which you have a substantial beneficial interest or as to which you serve as a trustee or in a similar capacity.

1. Printed Name of Employee, Board Member, or Volunteer(Required)

First Last

2. Capacity: Employee, Board Member, or Volunteer:(Required)

3. Have you or any of your affiliated persons provided services or property to Agape House of Prescott in the past year? YES or NO If yes, please describe the nature of the services or property and if an affiliated person is involved, the identity of the affiliated person and your relationship with that person.(Required)

Yes

If yes, please describe.

4. Have you or any of your affiliated persons purchased services or property from Agape House of Prescott in the past year? YES or NO If yes, please describe the nature of the services or property and if an affiliated person is involved, the identity of the affiliated person and your relationship with that person.(Required)

Yes

If yes, please describe.

5. Please indicate whether you or any of your affiliated persons had any direct or indirect interest in any business transaction(s) in the past year to which Agape House was or is a party? YES or NO If yes, please describe the nature of the services or property and if an affiliated person is involved, the identity of the affiliated person and your relationship with that person.(Required)

Yes

If yes, please describe.

6. Were you or any of your affiliated persons indebted to pay money to Agape House at any time in the past year (other than travel advances or the like)? YES or NO If yes, please describe the indebtedness and if an affiliated person is involved, the identity of the affiliated person and your relationship with that person:(Required)

Yes

If yes, please describe.

Attestation by Employee, Board Member or Volunteer: I confirm that the information I have provided in this Statement of Disclosure is true and complete.

Signature(Required)

Date Signed(Required)

Agape House of Prescott
EMPLOYEE AND VOLUNTEER
AGREEMENT TO MAINTAIN CONFIDENTIALITY

I acknowledge that during the course of performing my duties at Agape House of Prescott, I may have access to or use confidential resident, staff, volunteer, or donor information. I agree to handle such information in a confidential manner at all times during and after my employment or volunteer assignment ends. I will read the Confidential Information Policy, which is in both the Employee and Volunteer Handbooks, and will ask the Administrative Director if I have any questions.

Confidential information is any information I learn because of employment or volunteer service with Agape House that is not generally known to people outside of the organization. Information about residents, donors, donations, volunteers, and financial information relating to the organization; are among the information that must be kept strictly confidential. Employees and volunteers who work in positions where they are privy to personal information regarding employees (such as performing human resources or payroll tasks) must also keep that employee information confidential.

I understand that I have a legal obligation future physical and mental health or conditions; and, 2) the services that we are providing to them. That information is considered Protected Health Information (PHI) under the federal HIPAA law. Only persons with a clear need to know should receive such information. All employees and volunteers must keep PHI strictly confidential, including being careful to avoid being overheard by other In addition, I will not take photos or videos of residents without prior permission. If permission is granted, I will have an Agape House of Prescott photo release form filled out and signed.

I also understand that employees and volunteers who improperly use or disclose confidential Agape House or resident information, including PHI, will be subject to corrective action, which could include termination of employment or volunteer assignment, or legal action, even if they do not benefit from the disclosed information. This confidentiality obligation continues even after employees and volunteers no longer work or volunteer for Agape House

When my employment or volunteer assignment ends, I agree to return to the Administrative Director all Agape House confidential materials that I may possess. I further agree to not use or share with others, any confidential information for any reason. I will not give professional direction to residents after my employment or volunteer assignment ends.

Name of Employee/Volunteer(Required)

First Last

Signature of Employee/Volunteer(Required)

Date Signed(Required)

Agape House of Prescott

VOLUNTEER HANDBOOK ACKNOWLEDGMENT

I have received the Volunteer Handbook of Agape House of Prescott. I understand and agree that it is my responsibility to read and comply with the policies in this handbook, and any future revisions, within one week of receiving it. If I will be driving a vehicle on behalf of Agape House, I specifically will read the Driver Safety Policy and agree to abide by it. It is my responsibility to regularly review the handbook to ensure that I am familiar with the policies and consult with management if I have questions.

I understand that the handbook and all other written or electronic materials provided to me are intended for informational purposes only, and are subject to interpretation, review, and change by management at any time without notice. Neither the handbook, the organization’s policies or procedures, nor other communications create an employment contract or contract to volunteer for any specific period of time.

I agree that my volunteer assignment may be terminated by me or management with or without reason at any time.

When my volunteer assignment ends, I agree to return to the Administrative Director all Agape House confidential materials that I may possess. I will not give professional direction to residents after my volunteer assignment ends, unless otherwise authorized by Agape House.

I also understand that I have a continuing legal obligation to maintain the confidentiality of client protected health information (PHI). If I leave Agape House, either voluntarily or involuntarily, my obligation to not disclose any confidential client, donor, employee or other confidential Agape House information will continue even after I am no longer volunteering.

Signature of Employee/Volunteer(Required)

Date Signed(Required)

For Office Use Only:

___ Annual Review by Agape House, Date and Initial

Thank You for Your Interest in Agape House of Prescott!

Agape House of PrescottNew Volunteer Information Form