Name *
Name
Phone *
Phone
Address *
Address
Gender
Please specify the days and hours you are available to volunteer.
Summarize special skills and qualifications you have acquired from employment, previous volunteer work, or through other activities, including hobbies or sports.
Person to Notify in Case of Emergency *
Person to Notify in Case of Emergency
Emergency Contact's Phone Number *
Emergency Contact's Phone Number
Have you ever been convicted of a felony? *
If yes, please submit details.
Are you willing to submit to a drug screen?
If you are requesting to volunteer for activities involving CADA clients directly, please submit the following information
Agreement
AS A CONDITION OF VOLUNTEERING, I grant CADA permission to conduct legal background check(s) on me now and as long as I continue to volunteer for CADA, which will include, but not limited to, criminal history records and sex offender registries. I affirm that the information provided on this form is true, correct, and complete. I understand that if I am accepted as a volunteer, any false statements or omissions made by me on this application may result in my immediate termination. I understand that CADA personnel must be present for all activities directly involving CADA clients less than 18 years of age. I agree to keep confidential any and all matters related to CADA clients. I understand that the disclosure of the identity or information about clients to anyone except CADA personnel is a violation of federal addiction confidentiality law (42 U.S.C. sec. 290dd-2) and regulations (42 C.F.R. Part 2). I also release CADA and all parties involved from any and all liability due to loss, damage, and/or injury while volunteering for CADA. I also understand that the information that I submitted on this application will remain private and confidential