Cleveland Roots
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Volunteer Registration
Contact Information
Please complete the form to the best of your ability.
Name
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First Name
Last Name
Email
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Verify Email
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Primary Phone Number
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Address
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Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
Organization/Employer
Job Title
How did you hear about Cleveland Roots?
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Internet
Social Media
Friend or Family
School
Event
Days Available
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Times Available
Morning
Afternoon
Evening
Frequency
select one
Once Per Week
Twice Per Month
Once Per Month
Have you ever been convicted of any law violation (except minor traffic violations?)
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Yes
No
Please describe in full and give dates
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Have you ever volunteered before?
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Yes
No
Volunteer Organization Name
Please describe your volunteer experience (current and previous)
Special Skills or Qualifications
Volunteer Job Opportunities
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Planting
Harvesting
Storefront
Farmers Market
Training
Administrative
Person to Notify in Case of Emergency
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First Name
Last Name
Relationship
Emergency Contact Phone
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Emergency Contact Secondary Phone
Background Check Release
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I hereby authorize Cleveland Roots or other authorized representatives of the Agency bearing this Release, or copy thereof, within one year of its date, to obtain any information in your files pertaining to any felony convictions through First Advantage National Criminal File, sexual offences through the National Sex Offender Registry (Dept. of Justice) and for Social Security Number Verification. I understand if any misdemeanors are listed that Everyone's Wilson reserves the right to determine if I can continue as a volunteer. I hereby direct you to release such information upon request of the bearer. I hereby release you, as the custodian of such records, and any law enforcement agency, including its officers, employees, or related personnel, both individually and collectively, from any and all liability for damages of whatever kind which may at any time result to me, my heirs or associates, because of your compliance with this authorization and request to release information, or any attempt to comply with it or the nature of the information you provide. This Release is executed with the full knowledge and understanding that the information will be used in connection with the consideration of my volunteering by Cleveland Roots. Should there be any question as to the validity of this Release, you may contact the Agency as indicated above.
Yes
No
Statement of Applicant
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By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I'm accepted as a volunteer, any false statements, omissions, or other misrepresentations may result in my immediate dismissal. I understand that my current employer, the volunteer site that I have listed in my application and law enforcement/criminal records agencies may be contacted by Everyone's Wilson on my behalf.
Yes
No
Image Release
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I grant permission to Cleveland Roots, its employees and agents, to take and use visual/audio images of me. Visual/audio images are any type of recording, including but not limited to photographs, digital images, drawings, renderings, voices, sounds, video recordings, audio clips or accompanying written descriptions. I agree that Cleveland Roots owns the images and all rights related to them. The images may be used in any manner or media without notifying me, such as organization-sponsored websites, publications, promotions, broadcasts, advertisements, posters and theater slides. I waive any right to inspect or approve the finished images or any printed or electronic matter that may be used with them, or to be compensated for them. I release Cleveland Roots and its employees and agents, including any firm authorized to publish, broadcast and/or distribute a finished product containing the images, from any claims, damages or liability which I may ever have in connection with the taking or use of the images or printed material used with the images. I am at least 18 years of age and competent to sign this release. I have read this release before signing, I understand its contents, meaning and impact, and I freely accept the terms.
Yes
No
Please type your name. By doing so you are also indicating that you understand we will consider this an electronic signature.
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