OUR MISSION: To provide services and supports to people with barriers to attain self-direction, inclusion, personal fulfillment, and productivity in all life areas.
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Please fill in the appropriate times that apply to your schedule.
This agreement is intended to indicate the seriousness in which we treat our volunteers. The intent of the agreement is to assure us both of our deep appreciation for your services and to indicate our commitment to do the very best we can to make your volunteer experience a productive and rewarding one.
We, Developmental Services, Inc. (agency), agree to accept the services of [firstname lastname] (volunteer) beginning [date], and we commit to the following:
I, [firstname lastname], Agree to serve as a volunteer for Developmental Services, Inc. and commit to the following:
I, for myself and my heirs, executors, administrators and assigns, hereby release, indemnify and hold harmless DSI, Bartholomew County, and the City of Columbus from all liability for any and all risk of damage or bodily injury or death that may occur to me (including any injury caused by negligence), in connection with any volunteer opportunities through DSI in which I participate. I likewise hold harmless from liability any person transporting me to or from any DSI activities. In addition, DSI officials have permission to utilize any photographs or videos taken of me for publicity or training purposes. I will abide by all safety instruction and information provided to me during all DSI activities.
Further, I expressly agree that this release, waiver, and indemnity agreement is intended to be as broad and inclusive as permitted by the State of Indiana, and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.
I have no known physical or mental condition that would impair my capability to participate fully as intended or expected of me.
I have carefully read the forgoing release and indemnification and understand the contents thereof and sign this release as my own free act.
In order for your child to become a volunteer with our organization, we need your consent and your involvement in helping them have a productive experience. Please read and sign below.
Name of Agency: Developmental Services, Inc.
Name of Youth Volunteer: [firstname lastname]
I understand that my child named above wishes to be considered for a volunteer opportunity at DSI and I hereby give my permission for them to serve in this capacity, if accepted by the agency. I understand that they will be provided with orientation and necessary training for the safe and responsible performance of their duties and that they will be expected to meet all the requirements of the position, including regular attendance and adhere to agency policies and procedures. I understand that they will not receive monetary compensation for services contributed.
As an acting employee for DSI, your responsibility with regard to confidentiality extends even beyond your working hours. Failure to bide by the agency’s confidentiality code, even if it is inadvertent, can cause serious emotional injury and loss of opportunity to those who have placed their trust in us.
Please remember the following:
I hereby agree to this confidentiality agreement:
I HEREBY AUTHORIZE THE INDIANA BUREAU OF MOTOR VEHICLES TO RELEASE ANY AND ALL INFORMATION ON FILE REGARDING:
MY PERSONAL VEHICLE INSURANCE COVERAGE IS WITH:
In addition, I authorize Developmental Services, Inc. to request a Limited Adult Criminal History..