The following application includes:
1. Volunteer Application & Experience Forms
2. Media Release, Etc. Form
3. Criminal History Background Check
4. Volunteer Waiver & Release Form
5. State of Residence Other Than Iowa
6. Disclosure of Information Form
All volunteers must be 18 or older or accompanied by an adult.
Agreement and Signature
By submitting this application, I affirm that the facts set forth in this application are true and complete to the best of my knowledge.
1. I voluntarily waive, release and hold harmless the Horizons, A Family Service Alliance, its elected and appointed officials, officers, employees, agents and other volunteers from any and all claims, causes of action and damages for bodily injury or death that I may suffer as a result of, or in any manner connected with, directly or indirectly, my participation as a Horizons, A Family Service Alliance volunteer when such bodily injury or death is the result of my own negligent or intentional acts or omissions or those of another volunteer. I understand that this waiver and release precludes my right to recovery of damages in the event I am injured in the course of performing my volunteer duties.
2. I shall defend, hold harmless and indemnify the Horizons, A Family Service Alliance, its elected and appointed officials, officers, employees, agents and other volunteers, from and against all damages, claims, liabilities, causes of action, judgments, settlements, costs and expenses (including, but not limited to, reasonable expert witness and attorney fees) that may at any time arise or be claimed by any person as a result of bodily injury, death or property damage, or as a result of any other claim or cause of action of any nature whatsoever, arising from or in any manner connected with, directly or indirectly, my negligent or intentional acts or omissions in performing my volunteer duties.
I have read, fully understand and agree to the assumption of risk, waiver, release, hold harmless and indemnification terms set forth above.
If a criminal, dependent adult abuse, or child abuse conviction is reported by the D.C.I., additional investigation is required by the Department of Human Services. Allow 30 days for the results.
AN IOWA CRIMINAL HISTORY CHECK AND REGISTRY INFORMATION IS BEING REQUESTED ON:
Please complete the following information from the time you turned 18.
Please note that charges that have been deferred will be visible in a criminal background history report as will non-convictions.