Single | MOMM

First and Last Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Are you interested in serving at one of our events?

Check the box next to any way you are interested in serving.

Security

Meal serving

Kid activity stations

Infant - 4 year old helper

5 - 9 year old helper

10+ year old helper

Set up and/or tear down

Event planning team

Are you interested in helping in other ways?

Check the box next to any way you are interested in serving.

In our office

With practical needs (home repairs, vehicle help, moving, etc.)

Mentoring, teaching, facilitating classes for single moms

Emergency Contact Name:

First Name

Last Name

Emergency Contact Number: *

(###)

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Personal Reference (not related to you) *

First Name

Last Name

Personal Reference Phone Number *

(###)

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Professional Reference (not related to you) *

First Name

Last Name

Professional Reference Phone Number *

(###)

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Release and Waiver of Liability *

By checking this box you agree to all of the following: In consideration of the participation of helping Single MOMM, (SMOMM), the undersigned (volunteer). Hereby agrees to donate and offer his/her personal services and labor, free of charge, to Single MOMM. Volunteer understands and agrees that they are not an employee of SMOMM and are not entitled to any wages and/or benefits associated with their services. Volunteer acknowledges and understands that the activities include work that may be hazardous to the Volunteer, including but not limited to, construction, loading and unloading, and transportation to and from any venue,/work sites. Volunteer further agrees, on behalf of himself/herself and on behalf of his/her heirs, assigns, trustees, receivers, administrators, executors and agents to release and forever discharge SMOMM, their directors, officers, employees, agents, volunteers, invitees, sponsors, cash donors, in-kind donors, and all other personas or entities whomsoever (SMOMM), of and from any and all actions, claims, and demands, known or unknown, which Volunteer has or may have in the future arising out of volunteering for SMOMM. Additionally, Volunteer specifically releases any subrogation rights that might arise. Volunteer understands that this Release discharges SMOMM for any liability or claim that the Volunteer may have against SMOMM with respect to any bodily injury, personal injury, illness, death or property damage that may result from Volunteers activities with SMOMM whether caused by the negligence of SMOMM or its officers, directors, employees, or agents or otherwise. Volunteerunderstands that SMOMM does not assume any responsibility for or obligation to provide financial assistance or other assistance, including but not limited to medical, health, or disability insurance in the event of injury or illness. Volunteer does hereby grant and convey unto SMOMM all right, title and interest in any and all photographic images and video or audio recordings made by SMOMM during the Volunteers’ work for SMOMM including, but not limited to, any royalties, proceeds, or other benefits derived from such photographs or recordings. The undersigned acknowledges that he/she has read this Release and understands that this Release may be pled as a complete bar and defense to any action or other proceedings instituted or filed by Volunteer on account of any matter contained herein. Volunteer expressly agrees that this Release is intended to be as broad and inclusive as permitted by the lows of Michigan and that this Release shall be governed by and interpreted in accordance with the laws of Michigan. Volunteer agrees that in the event that any clause or provision of this Release shall be held to be invalid by any court of competent jurisdiction, the invalidity of such clause or provision shall not otherwise affect the remaining provisions of this Release which shall continue to be enforceable. I authorize, at Single Mom Ministry’s discretion, investigation of all statements made by me in this application, and review of any civil or criminal records which may exist, concerning me, except for such records as are sealed according to state or federal law. I further authorize SMOMM at its discretion, to contact references and others whose names are provided on this application form, or whose names, may be identified by me in an interview, and I authorize such persons to provide SMOMM with information requested by SMOMM regarding me. I further release any such individuals, as well as SMOMM for any claims I might have arising out of any discussions involving me, or the provision of any information or records regarding me Volunteer Responsibility. If for any reason I believe that my working as a volunteer for SMOMM might endanger myself or others or I have knowledge of or suspect any dishonest, deceptive, illegal or unethical activities, I must report this to the Executive Director immediately at the site, and the SMOMM employee overseeing the volunteer activity. This might include, among other things, improper use of agency property, communicable diseases, physical impairments, and medication (prescription and/or otherwise that might impair my judgment). I am volunteering for SMOMM at my own risk.

Check here to agree to the above.

Background Check *

By checking this box you agree to allow Single MOMM to conduct a background check on you. (This is absolutely necessary to be a volunteer)

Confidentiality *

By checking this box I understand the importance of client and ministry confidentiality. Therefore, I agree to the following: I will not discuss Single MOMM clients or ministry information out of the Single MOMM office or program area except to the appropriate authorities in 
circumstances where it is required by law. / I will not discuss clients or ministry relationships with my friends and/or family 
unless I have written permission from Single MOMM first. / I understand that it is not my responsibility to “inform” anyone of our client’s situation, or of the fact that she has been participating with Single MOMM. / I will respect the client and ministry’s privacy at all times. / My goal as a Single MOMM Volunteer is to help the clients and ministry in a loving, caring, and non-judgmental way.

Check here to agree to the above.

Identification Photo *

By checking this box I agree to fax, mail, email, or hand-deliver a photo of the front and back of my driver's license or state ID