Volunteer Application
*
Required Fields
Contact Information
First Name
*Required
Middle Initial
*Required
Last Name
*Required
Nickname
Address
*Required
Address 2
City
*Required
State/Province
*Required
Alabama
Alaska
Alberta
Arizona
Arkansas
Armed Forces Americas
Armed Forces Other
Armed Forces Pacific
British Columbia
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Manitoba
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Brunswick
New Hampshire
New Jersey
New Mexico
New York
Newfoundland & Labrador
North Carolina
North Dakota
Northwest Territories
Nova Scotia
Nunavut
Ohio
Oklahoma
Ontario
Oregon
Pennsylvania
Prince Edward Island
Puerto Rico
Quebec
Rhode Island
Saskatchewan
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington DC
West Virginia
Wisconsin
Wyoming
Yukon
Zip/Postal Code
*Required
Home Phone
Cell Phone
*Required
Work Phone
Email
*Required
Your entry is not a valid email address!
Gender
*Required
Male
Female
Other
Birthdate
mm/dd/yyyy
mm/dd/yyyy
Have you been convicted of a crime?
Yes
No
* Have you been convicted of a crime? is required.
If yes, please explan description of the conviction:
Are you over 18?
Checking this box indicates parental/guardian consent to volunteer
Are you a current or former Sunshine Communities Employee?
Yes
No
* Are you a current or former Sunshine Communities Employee? is required.
Are you volunteering with a group? If so, please list group.
Is volunteering required for school?
Yes
No
Are you a part of a nursing clinical group? What school?
*Required
Number of hours required
Name of School
Volunteer Information
Do you have any physical needs
that require special arrangements?
No
Yes
If yes, please explain
Please list any allergies or medical conditions
Vaccination Information
In 2022, the US Supreme Court upheld the CMS Covid-19 vaccine rule set in place for healthcare workers. Agencies like Sunshine that receive Medicaid or Medicare funding are covered by this decision. In order to comply with this rule, Sunshine is required to ensure that all employees, volunteers, and students become either fully vaccinated OR have an approved exemption for medical reasons or personally held religious beliefs.
Are you fully vaccinated with two doses of Pfizer or Moderna, or one dose of J&J?
*Required
Yes
No
Are you able to provide proof of vaccination, or proof of exemption?
*Required
Yes
No
Emergency Contact Information
Title
Ms.
Mrs.
Miss
Mr.
Dr.
Sr.
Fr.
Full Name
*Required
Address
*Required
City/State/Zip
*Required
Phone
*Required
Relationship
*Required
Signature/Waiver
HIPPA Agreement: All information (writeen and verbal) at Sunshine is confidential and will not be shared with anyone without the expressed written consent of the participant and/or guardian
I agree
Yes
No
* I agree is required.
Liability waiver: I understand and agree that there are potential risks that are associated with volunteering, both forseeable and unforseeable. By checking the box below, I hereby waive and release any and all connection with my involvement with Sunshine. I also waive and release any and all rights and claims for lost or stolen property and I release any and all rights and claims for damages by my heirs, executor and or/administrators.
I agree
Yes
No
* I agree is required.
Electronic signature: By signing this application, I authorize Sunshine to verify any information provided. I understand that as a volunteer, I must work with and under the supervision of the volunteer manager and site supervisors. I also understand that if accepted for volunteer service, I must abide by the policies and regulations of Sunshine. I understand that Sunshine is not obligated to provide placement, nor am I obligated to accept any placement that might be offered. I'm volunteering freely for public service, religious, or humanitarian objectives without contemplation of compensation.
Checking this box is equivalent to an Electronic Signature agreeing to all information contained in this application.
I agree
* Checking this box is equivalent to an Electronic Signature agreeing to all information contained in this application. is required.
Today's Date M/D/YYYY
mm/dd/yyyy
mm/dd/yyyy
Photo Release: Sunshine would like to be able to use volunteer for promotional materials. This section applies specifically to portraits/recognizable photos taken during volunteer time. Photo consent does not apply to crowd distance photographs. By checking the box below, I am verifying that I consent to the use of photo/visual and audio materials to be used for promotional materials, educational activities and exhibitions for the benefit of Sunshine.
I agree
Yes
No
* I agree is required.
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Thank you for your interest in volunteering at Sunshine Communities.
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