Children's Healing Art Project (CHAP) · CHAP Volunteer Application for Adults

Contact Information

Name

First Name

Last Name

Middle Name *

If you do not have a middle name, please write: N/A

Preferred Pronouns:

Email *

Please provide an email. This is the main way we communicate with our volunteers.

Verify Email *

Phone

Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Emergency Contact Information

Name *

First Name

Last Name

Preferred Pronouns:

Relationship to Volunteer

Phone *

General Information

Are you volunteering to fulfill a service requirement?

If yes, please indicate hours required and date volunteer hours must be completed by.

How long would you like to volunteer with CHAP?

Which activities are you interested in volunteering for?

(Please check all that apply)

CHAP Studio

Hospital Art Program ( minimum 2 months at Studio, then minimum 6 month commitment at the Hospital)

Art Club

Art Parties + Workshops

Outreach Events

CHAPlandia

What day(s) are you typically available to volunteer?

Please check all that apply (Note that the Studio is typically closed on Sundays and Mondays, although occasionally we need volunteers to help staff events on Sundays)

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Other Skills

(Please list other skills that you believe might be helpful at CHAP, as well as specific languages you speak other than English if you checked that box above.)

Why do you want to volunteer with CHAP?

What else should we know about you?

Demographic Information (optional)

CHAP is working to collect demographic information about participants to ensure diversity, equality and inclusion in our programs.

Ethnicity

Please check all that apply

African American or Black

Asian (East Asian)

Asian (South East Asian)

Latinx

Native American or Alaskan Native

Native Hawaiian or Pacific Islander

White

Other (please specify)

Declined Response

Image Release

I consent to, and authorize the taking, use, and reproduction of images and audio, of me at Children’s Healing Art Project (CHAP) by any media entity or individual hired by CHAP. I understand that I will not be compensated for the use of my images. This release shall remain in effect unless and until I notify CHAP of my revocation in writing, and agree that such revocation will apply only to materials, presentations, or publications produced or printed by CHAP after receipt of my written notification.

*

I agree to be photographed

Applicant's Certification

CHAP is an equal opportunity employer and does not discriminate on the basis of sex, age, race, color, religion, national origin, mental or physical disability, marital status or military service or any state protected classifications. We honor and value diversity in the workplace. No applicant will be rejected as a result of an impairment that with reasonable accommodation does not prevent performance of the work. CHAP does not tolerate sexual harassment or harassment on the basis of any protected class status in the work place. I certify that I have answered truthfully and have not knowingly withheld information relative to my application. I understand that any misrepresentation or material omission on the application will result in my being eliminated from further consideration. I further understand that, if accepted to volunteer, any misrepresentation or material omission that becomes known to CHAP may result in my immediate termination. If accepted to volunteer, I agree to adhere to all existing and future instruction, rules, and policies of CHAP. I understand that my position can be terminated at any time, at the option of either CHAP or myself. I agree that I offer my services as a volunteer with no exception of monetary compensation and that I am to fulfill the commitment as outlined including any required training.

I have read and reviewed the above statements and other information provided in the handbook. *

check box to indicate yes

Digital Signature

First Name

Last Name

Date of Birth *

MM/DD/YYYY

Gender

Female

Male

Other