Volunteer Registration Form

First Name Last Name Birth Date(MM/DD/YYYY) / / Gender: Female Male They/Them Email Phone If you are volunteering with a group, please let us know the name of the organization Emergency Contact Name Emergency Contact Relationship Emergency Contact Phone Address: Address Line 2 City: State/Province: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming American Samoa Federated States of Micronesia Guam Marshall Islands Northern Mariana Islands Palau Puerto Rico U.S. Minor Outlying Islands Virgin Islands Armed Forces Americas Armed Forces Europe, the Middle East, an Armed Forces Pacific Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Territory Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory Zip Code: - Zip Suffix Do you have Medical Insurance? All R.O.C.K. Volunteers are required to have medical insurance. Yes No COVID-19 Vaccine Card: Volunteer (Date of last negative TB test result) Have you been diagnosed with tuberculosis, or have reason to believe you may have been in contact with someone with tuberculosis in the last 4 years? Negative TB result?: Yes No N/A Please check any that apply: I have current symptoms of Tuberculosis (coughing up blood, night sweats, fever, excessive fatigue) I was born in or have lived or traveled in a country with an elevated TB rate for at least 1 month I've been in close contact with someone with infectious TB during my lifetime Have you been convicted of a felony?(Answering yes will not automatically prohibit individuals from becoming volunteers, but will be considered with respect to time, circumstances, seriousness and relationship to volunteer responsibilities.) Yes No If yes, please explain If one day Volunteer: Please enter date Are you interested in a specific one-time volunteering activity or in volunteering more than once? One-Time activity (i.e. a specific group volunteering event) More than once (or you are unsure) If you are volunteering with a group, what is the company/organization and date of volunteering (e.g. Salesforce 10/31 or SFSU 2/14)? Which of the following are you registering for (choose the best answer)? An activity working directly WITH youth (e.g., sports, tutoring, company group volunteering, etc.) An event NOT directly working with youth (e.g. event set up, happy hour, etc.) I would like the option to volunteer for all types of activities and events! Volunteer Activity. If you know what program you would like to help out with, let us know. Experience working with kids Minimum of 2 References By checking this box I give R.O.C.K. permission to use pictures of me on thank you cards, website, newspaper, television and/or any other marketing/media materials about R.O.C.K.. Not checking this box will not effect your eligibility to volunteer. Volunteer Expectations:
What does R.O.C.K. expect from volunteers?
●R.O.C.K.’s programs are designed to build relationships with children while offering them opportunities to gain a sense of accomplishment and fun. R.O.C.K. volunteers are asked to sign up for a minimum number of sessions during a program so that children can depend on consistent and trusted adults being present.
● Promptness and dependability
●Flexibility
● Initiative
● Patience
● Imagination and creativity
● Sense of humor
● Discretion and trustworthiness with confidential matters relating to kids and their families
● A warm, positive, and supportive attitude
● Sensitivity to children’s needs
● Respect for team work and co‐workers
● Maintain your sense of humor at all times
● Minimize profanity and inappropriate conversations
● Be a role model to the participants
● Be present with the participants and the activity, please keep your phones away
● Try to never be alone with a participant – have at least two participants or another leader present
● Make sure to always have communication with the leaders
● Do not befriend participants in any social forum: Facebook, Twitter, Instagram, etc.
● Do not post any pictures of participants on social forums
●Be appropriate about physical contact
-Examples of appropriate behavior: Giving high fives, giving side hugs, patting on back or shoulder and nothing more
-Examples of inappropriate behavior we do NOT accept: Lap sitting, swinging and/or spinning children, giving piggy back rides, wrestling and play fighting, hugging and/or kissing

What can a R.O.C.K. volunteer expect from R.O.C.K.?
● Appreciation and respect
● Clear communication
● Training and demonstrations of how to work with kids in specific situations
● Appropriate matches between volunteers and children
● Training and development in building positive, satisfying relationships with children
● Training and support in behavior management

I have read the above and accept and agree to the terms and expectations listed above. Yes No Volunteer Waiver, Release and Indemnity AgreementBetween Real Options for City Kids (R.O.C.K.), hereinafter referred to as R.O.C.K. and the person filling out this form indicated by the First and Last name listed below, hereinafter "the volunteer". This document sets forth the responsibilities and understandings of you, the volunteer and of R.O.C.K. regarding volunteer’s participation in volunteer programs partially or wholly coordinated by R.O.C.K..The volunteer and R.O.C.K. agree as follows:
1. The volunteer performs the service of the volunteer’s own free will, without promise, expectation, or receipt of remuneration. The volunteer is not an employee or agent of R.O.C.K. for any purpose and the volunteer’s services are not controlled nor mandated by R.O.C.K.
2. The volunteer understands and agrees that it is possible that the volunteer may be injured or otherwise harmed during volunteer service due to accidents, acts of nature, the volunteer’s negligent or intentional acts, or the negligent or intentional acts of others; that while R.O.C.K. has taken some steps to reduce the chances of injuries or harm to the volunteer, that R.O.C.K. has no control over most risks, and, thus, cannot and does not guarantee nor take any responsibility for the safety of the volunteer or the volunteer’s property while the volunteer is engaged in volunteer service; and that the volunteer must take full responsibility for himself or herself and assume the risk of harm or damage while serving by taking all necessary and reasonable precautions and acting in a manner that will help protect himself or herself and his or her property.
3. The volunteer agrees to waive and release R.O.C.K. from any and all potential claims for injury, illness, damage, or death which the volunteer may have against R.O.C.K. that might arise out of the volunteer’s service and to hold R.O.C.K. harmless there from.
4. The volunteer agrees and understands that injuries or losses to others, such as co-workers or the person(s) being helped, may occur as a result of the volunteer’s negligent or intentional acts during volunteer service, and that to avoid such harm, the volunteer must exercise care and act responsibly in serving others.6. If any injury or loss to another does occur due to the volunteer’s intentional actions or due to volunteer’s negligent actions arising outside of the scope of the volunteer’s activities, the volunteer must accept the liability for and repair, or make reparations for, the harm done.
5. R.O.C.K. is not providing the volunteer with insurance coverage for any injuries, conditions, or losses to the volunteer arising out of volunteer activities, except that R.O.C.K. does provide liability insurance coverage on all R.O.C.K. vehicles used during service projects.
6. The volunteer must maintain his or her own primary medical insurance and the volunteer’s own automobile liability insurance when driving a non-R.O.C.K. vehicle to cover potential medical and other costs related to the volunteer service; and the volunteer is also encouraged to maintain property and life insurance coverage while serving as a volunteer.
7. All costs for injury or loss above the coverage provided by the volunteer’s insurance are the volunteer’s personal responsibility.
8. In projects where the volunteer will be transporting others in a non-R.O.C.K. owned vehicle, the volunteer will be required to provide proof of automobile insurance in order to participate.
9. Since volunteers are not R.O.C.K. employees, R.O.C.K. does not provide workers’ compensation coverage for injuries or illnesses to the volunteer arising out of volunteer activities.
10. I agree to undergo a background check if necessary to volunteer. I have the right to ask about the nature and scope of the background check report. I have the right to dispute any inaccurate information on the report and I am entitled to copies of the report.
11. I will hold harmless the San Francisco Unified School District, its officers, employees, and agents form any and all claims that may arise related to my volunteer activities whether or not caused by me.
12. I also agree that if I am exhibiting any active symptoms of any flu-like illnesses, including but not limited to coughing, frequent sneezing, chest pains, fever or night sweats, that I will not volunteer that day. I understand that the materials and tools provided by R.O.C.K. are and remain the property of R.O.C.K., and I agree to return these tools and any remaining materials to R.O.C.K. at the end of my volunteer service.

By checking the box below, I confirm that I have carefully read and fully understand its contents. I am aware that this is a release of liability and signed it of my own free will.  I have read the Volunteer Waiver above and accept the terms. I have NOT read the Volunteer Waiver and/or DO NOT accept the terms and understand I will not be eligible to volunteer. I have full confidence that every precaution will be taken to ensure my safety during my participation as a volunteer in R.O.C.K. programs, I hereby waive all claims against R.O.C.K., R.O.C.K. staff, R.O.C.K. Board of Directors, and/or R.O.C.K. partnering organizations in the event that an accident or injury should occur. By checking "I Agree" below, I am effectively providing my signature, indicating that all the information on this form is true and accurate to the best of my knowledge. I am effectively providing my signature, indicating that all the information on this form is true and accurate to the best of my knowledge.