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Volunteer Registration
Contact Information
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First Name
Last Name
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Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Country
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Please list your allergies and/or medical conditions.
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First Name
Last Name
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Please enter it in the format 1/2/2020
Volunteer Agreement

As a registered volunteer, I agree to:

  • Volunteer my services to HCSEG by my own free choice. I understand that I will receive no
    wages for the work performed.
  • Perform only volunteer duties that are assigned to me, according to HCSEG policies and
    procedures.
  • Complete and submit volunteer time records to HCSEG after each service date before the end of each month.
  • Adhere to all HCSEG standards regarding ethics, safety, nondiscrimination, confidentiality
    and respect for others, as well as abide by the laws and regulations of the State of
    Washington.
  • Complete any required training and adhere to all safety requirements. I will not accept any
    work assignment for which I feel I am not prepared.
  • Take responsibility for the safe use, maintenance and repair of any tools and safety
    equipment.
  • Assume all risks related to my assignment. I waive all claims for personal injuries or
    damages to property against the state of Washington and HCSEG, and hold its officers and
    employees harmless from all claims and liabilities of whatsoever nature arising out of my
    participation in any, and all, aspects of HCSEG's volunteer program.
  • Keep your volunteer sign-up password private. By submitting this form, you are agreeing you will not share the sign-up password with others. You will be sent a password after registration.

 

NOT AN EMPLOYEE OF HCSEG

I understand that I am not an employee of HCSEG. I further understand that I will not hold myself out as, or claim to be an officer or employee of HCSEG or take any claim of right, privilege or benefit which would accrue to an employee. I do not expect to receive any personal monetary wages for services rendered through volunteer activities.

MEDICAL / WORKERS COMPENSATION INSURANCE
I understand that as a registered volunteer, through the Department of Labor and Industries, HCSEG provides registered volunteers with worker’s compensation insurance for medical aid for injuries sustained while engaged in volunteer activities. I further understand that this coverage does not apply to disability or injuries caused by pre-existing medical conditions.

HOLD HARMLESS
I agree to hold harmless and waive all claims of liability against HCSEG arising out of my performance as a volunteer.

LIABILITY INSURANCE
I understand that if I use my private motor vehicle in the course of my volunteer duties, it is my obligation to obtain and maintain state required liability insurance to cover any accidents involving my vehicle. I further understand that it is my responsibility to obtain and maintain insurance policies for damage, loss or liability on all personally owned, leased or rented equipment, vessels, horses, etc, I use while performing assigned volunteer work.
I further agree that should I be involved in an accident while performing assigned duties as a volunteer, I will report such accident immediately to the HCSEG program manager/supervisor of the volunteer activity.

NONDISCRIMINATION
I understand that during my performance as a volunteer for HCSEG, I shall comply with all federal and state nondiscrimination laws, regulations and policies.

BACKGROUND INVESTIGATION
I understand that the agency may conduct a background investigation as part of this application process. I hereby authorize the background investigation by my signature below. You may not participate in volunteer activities until you have passed WATCH background check and received a verbal or written confirmation of your background check results.

I hereby register as a volunteer worker for HCSEG. I acknowledge by my signature below that I will accept my responsibility as a HCSEG volunteer. I will comply with all policies and procedures outlined by the HCSEG volunteer manual. I understand that I will not receive wages for services rendered. I understand that each month I must submit, via timesheet, my hours worked as a HCSEG volunteer. Submitting monthly hours worked to HCSEG is a requirement for medical aid coverage through the Department of Labor and Industries. Failure to document my time and submit monthly timesheets may make me ineligible to receive such medical aid coverage.

By submitting this form, you agree to these terms.

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Depending on the nature of the volunteer activity that you will be participating in you may be asked to provide some, or all, of the information requested below

Your HCSEG volunteer supervisor will let you know if you need to complete any of the sections below.

 

DRIVING

Volunteers who will be assigned to operate state vehicles or privately owned vehicles as part of their volunteer duties you will be asked to:
  • Present a driver’s license valid under Washington State law when requested by your WDFW
    Volunteer Supervisor.
  • Provide a “complete record” of your Abstract of Driving Record (ADR) , when requested by
    your WDFW Volunteer Supervisor, which can be obtained from the Washington State
    Department of Licensing.
  • Tell your WDFW volunteer supervisor whether you do or do not have at least two years of
    driving experience.

 

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Do you have a first aid card?
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(mm/dd/yyyy)
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If you answered yes please provide a written explanation with your application materials.
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If you answered yes please provide a written explanation with your application materials.
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