volunteer/instructor application

Please complete this form to apply to become a volunteer/instructor

Name *
Name
Address
Address
Home Phone
Home Phone
Cell Phone
Cell Phone
Preferred mode of communication
Age range *
T-Shirt size (adult sizes)
Skills, experience and interests (check all that apply)
What is your availability to help (check all that apply)
What locations are you willing to help in (check all that apply)
Instructors ONLY: *
Desired compensation
Name of Reference (non-related)
Name of Reference (non-related)
Phone number of Reference
Phone number of Reference
Name of 2nd Reference (non-related)
Name of 2nd Reference (non-related)
Phone number of 2nd Reference
Phone number of 2nd Reference
Certification of Submitted Information
The above information is true and correct. I understand that, in the event of my volunteer and/or contract with WeeBits, Inc., I shall be subject to dismissal if any information that I have given in this application is false or misleading or if I have failed to give any information herein requested, regardless of the time elapsed after discovery.

Please complete the following consent form (can be completed at a later time/prior to starting)

Emergency Contact *
Emergency Contact
Emergency Contact Home Phone
Emergency Contact Home Phone
Emergency Contact Cell Phone
Emergency Contact Cell Phone
Medical Consent/Authorization
In the event I am accepted for service, I, hereby grant permission to WeeBits and/or it representatives to procure emergency medical treatment that they deem reasonably necessary to my health and well-being. Also, when deemed reasonably necessary or advisable, I grant permission for hospitalization at an accredited hospital. I further authorize WeeBits, and/or its representatives, to release medical information reasonably necessary to render such medical treatment.
Expression Assumption of Risk
In the event I am accepted for service, I hereby assume all risks associated with volunteering with WeeBits. I agree to hold WeeBits harmless and will refrain from bringing, continuing or participating in any suit against WeeBits, its employees, agents, officers, representatives or volunteers with respect to any and all claims, demands, losses or liabilities of any kind or nature which may arise in connection with injuries suffered while volunteering, except for injuries resulting from the direct willful misconduct of WeeBits, its officers, agents, or employees. I further agree that in the event that I or anyone on my behalf bring, continue in or participate in any suit against WeeBits or any of its employees, agents, officers, representatives, or volunteers in connection with injuries suffered while volunteering, and WeeBits substantially prevails in a court proceeding, meditations, arbitration or settlement, including but not limited to, involuntary or voluntary dismissals, I will reimburse WeeBits for all costs of defense, including legal fees and expenses.
Photo Release
I hereby authorize WeeBits to use pictures, video and recordings either provided by me or taken by WeeBits or its agents to further the mission of WeeBits. Furthermore, I fully and forever release and discharge WeeBits of and from any and claims, demands, actions, causes of action, suits controversies and liabilities of any kind and nature accruing to me or to them and arising direct or indirectly from the use of names, photographs, pictures, video or recordings.
Express Consent for Background/Fingerprint Check (for Instructors and/or Volunteers working directly with children)
I hereby authorize WeeBits and/or its representatives to conduct a criminal and civil background check and to communicate with respect to any information they may give and about me. I hereby authorize WeeBits to conduct a search of the Child Abuse and Neglect Tracking System to determine whether I have been a perpetrator of an indicated incident of child abuse and/or neglect or involved in a pending investigation. WeeBits uses Accurate Biometrics to process your fingerprinting. Please go to the Accurate Biometics website to find a location nearest you using your zipcode. It will provide available dates and times for your screening. http://www.accuratebiometrics.com/fingerprint_Results_By_Zipcode.php You have to bring a WeeBits Fingerprint Application form to take to with you. To obtain this form or have any questions contact info@WeeBitsforfamilies.org. or call 224-360-2542. This process will be at no cost to you.
Privacy Policy
WeeBits values your privacy and we realize that visitors to our website may have concerns about their privacy and security. We are therefore providing the following information explaining our online information practices. The policy may change from time to time without notice. By visiting our site and making donations online, you agree to the practices outlined in this Privacy Policy. PRIVACY: We respect and are committed to protecting your privacy. We may collect personally identifiable information when you visit our site. We also automatically receive and record information on our server logs from your browser including your IP address, cookie information and the page(s) you visited. We will not sell your personally identifiable information to anyone. SECURITY: We strive to meet industry standards to secure your personally identifiable information. Our Secure Sockets Layer (SSL) software is among the best software available today to secure your personally identifiable information when making a transaction. When you choose to make a donation, you will be directed to PayPal to conduct the transaction. PayPal’s privacy policy describes the information they collect and how the information is used. PayPal takes the processing of your personal information very seriously and will use your information only in accordance with the terms of their Privacy Policy. We strongly encourage you to review PayPal’s Privacy Policy when you conduct a transaction.
Consent to Terms and Conditions
By checking the "I AGREE box": I acknowledge that I have read this application and agree to all contained herein; I also attest that all statements made in this application are accurate and truthful and I understand that any misrepresentations or false statements made in this application may result in being declined for service or terminated from service.
Minor Release and Parent Consent
If the volunteer is between the ages of 15 and 18 please e-mail info@weebitsforfamilies.org or call 224-360-2542 to obtain the parental release form.
By providing you name/signature, you are in agreement that all information is accurate and true
By providing you name/signature, you are in agreement that all information is accurate and true