Volunteer Sign Up Limited Engagement Volunteers Name* First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email Phone*Employer or School Attending:Emergency contact during this visit* First Last Emergency contact's phone*Are you at least 18 years of age? Yes No Is this your first time volunteering with BGCAZ? Yes No Date of club visit or event* MM slash DD slash YYYY Club Location or Event*EventJerry Colangelo BranchI.G. Homes BranchWarner & Shirley Gabel BranchMLB All-Star D-Backs BranchBob & Renee Parsons BranchJerry & Helen Wisotsky Peoria BranchEd Robson Family BranchHarry & Sandy Rosenzweig BranchLouis & Elizabeth Sands BranchSpencer D. & Mary Jane Stewart BranchSwift Kids BranchTri-City West/Thornwood BranchBob & Renee Parsons Dental ClinicProgram Services CenterWhat is the name of the event?*Homework Hero? Yes I want to receive your newsletter Yes Voluntary DisclosureGender Male Female Race Black or African American White Asian American Indian or Alaska Native Hispanic or Latino Native Hawaiian or Other Pacific Islander Two or More Races For Disabled/Veteran Status Individual with a disability Disabled Veteran Veteran of Vietnam Era Veteran DisclosureThe Boys & Girls Clubs of the Valley requires all current staff, volunteers and applicants being considered for employment to undergo a criminal background investigation. The following criteria are grounds for immediate disqualification from the employment (or volunteer) process: Has recent record of arrest (within last 5 years) Has repetitive history of arrests Has ever been arrested, convicted of, or had a plea agreement in relation to any of the following crimes: Sexual assault, abuse, exploitation, molestation, incest, prostitution of a minor or vulnerable adult. Contributing to the delinquency of a minor, or any other crime against children or vulnerable adults. Domestic violence or animal abuse Kidnapping, assault, aggravated assault, manslaughter, murder Criminal sale, distribution, transportation or use of marijuana, illegal drugs or alcohol Crimes involving weapons, burglary, robbery Have you ever been convicted of, admitted committing, or are you awaiting trial for any of the above, or similar, crimes? Yes No Have you been arrested for any crime within the past five (5) years? Yes No Please initial each section and sign below.BGCAZ CONFIDENTIALITY STATEMENT:*Similar to a Boys & Girls Clubs of the Valley (BGCAZ) employee, you as a volunteer are bound by a code of ethics to keep confidential matters within the confines of this organization. While providing service with the Boys & Girls Clubs of the Valley information about the lives, abilities, and concerns of youth may be shared with you. This information is of a confidential nature. You must understand and respect the rights of privacy of our members and their families. You are required to use sound judgment in handling confidential information, including reproducing copies of documents or disseminating information inside or outside the organization. You may not discuss such information with anyone who does not have a professional right to know. SOCIAL MEDIA POLICY:*This policy applies to all BGCAZ staff, volunteers, consultants and business partners. Social media includes networking sites, rapid-fire communications, blogs, instant messaging, email and personal websites (‘social media sites”), i.e.: Facebook, Twitter and similar sites. Material and photos referencing BGCAZ or its members or staff can only be presented or shared online with the prior express approval of the Marketing & Communications Dept. Photos or texts about members cannot be shared without the prior express approval of the Marketing & Communications Dept. Do not use BGCAZ’s logos or trademarks unless you have a previously approved legitimate business purpose. If you find an error online about BGCAZ contact the Marking & Communications Dept. You should not “recommend, “follow,” or “like” current or former staff on behalf of BGCAZ. Do not connect with current members or with former members under the age of 18. Do not “tweet” or “post” your location while volunteering unless you have received prior approval from the Marketing and Communications Department. WAIVER & RELEASE OF LIABILITY:*I hereby release the BGCAZ, its employees, officers, volunteers, and agents from any and all claims, demands, rights, and causes of action that may arise from my volunteer work with the BGCAZ. I am assuming the risk for any mental or physical harm I might incur. I agree that all personal possessions/property kept in the BGCAZ buildings, on BCGAZ property, and on any property used by the BGCAZ are my own responsibility. BGCAZ will not be held liable for any damage, loss or theft. I understand that BGCAZ provides charitable services to the public and does not pre-screen members. I acknowledge that I have had full opportunity to read this document and to seek legal advice should I choose. I agree that this agreement is intended to be as broad as permitted by the laws of the state of Arizona. I have carefully read this liability waiver and I fully understand its contents. I accept the terms and conditions of volunteer statues with the Boys & Girls Clubs of the Valley including authorization to conduct pre-volunteer criminal background screening, drug testing for volunteers transporting youth, and reference check investigations. VOLUNTEER PHOTO & NAME RELEASE:*I hereby authorize and give full consent to the BGCAZ to copyright, publish all photographs and/or motion pictures and/or voice recordings taken by the organization or heir agents in which I appear. The voice stills, and/or motion picture recordings may be distributed worldwide, including the Internet and may also be used in the future for promotional purposes of the BGCAZ or its affiliates. I acknowledge that this information may be sent to the press and any other media the BGCAZ deems appropriate including my first name and last name. Sign*E-sign your submission by adding your name below.CAPTCHA
