Volunteer Application – Bridge Street Ministries

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Privacy
All information provided in this application will be securely stored and used solely by the BSHOP staff for administrative purposes only.
General Info
Name*
First Last
Home Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Is your home address the same as your current address?*
Current Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone Number*
Email*
Enter Email Confirm Email
Age*
Picture
Feel free to upload a picture so we can put a face to the name 🙂

Screening and Background Information
Please note that any volunteers working with or around children, youth, or adults with developmental disabilities are required to provide all of the following information, and consent to relevant background checks prior to their start date.
Have you ever been convicted of a crime?*
Please explain.
Have you ever been asked to step away from a staff or volunteer role working with children, youth, or adults with developmental disabilities?*
Please explain.
I hereby authorize the BSHOP to obtain information pertaining to any charges and/or convictions I may have had for violation of municipal, county, state or federal laws. This information will include but not be limited to that obtained via police records, the National Sex Offender’s Registry, and the DHS Central Registry.
Background Consent
I agree.
I hereby authorize the BSHOP to obtain information pertaining to any charges and/or convictions I may have had for violation of municipal, county, state or federal laws. This information will include but not be limited to that obtained via police records, the National Sex Offender’s Registry, and the DHS Central Registry.
Date of Birth
Date Format: MM slash DD slash YYYY
Gender
Race
Driver's License Number or State ID
State of Issuance
State / Province / Region
Medical Information
Do you have any allergies, physical limitation, or medical conditions that may require special attention?
Emergency Contact*
First Last
Relationship to You
Phone (home or mobile)*
Phone (work)
Email*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Reference
Please include a reference. This person must be over the age of 18 years, they must have known you for at least 1 year, and they must be a non-family member.
Name*
First Last
Relationship to You
Contact Information*
Reference #2
Name*
First Last
Relationship to You
Contact Information*
Reference #3
Name*
First Last
Relationship to You
Contact Information*

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Monthly E-Newsletter
Do you want to sign up for our monthly e-newsletter?
Photographical Consent
I hereby give permission to the Bridge Street House of Prayer (BSHOP) for use of my picture in any promotional material including advertising, brochures, publications, video productions, or any social media uses. I waive the right to any fee or compensation for either the use or reproduction of the resulting photographs in any medium. I understand these materials may be used by the BSHOP.
Photographical Consent
I agree.
I hereby give permission to the Bridge Street House of Prayer (BSHOP) for use of my picture in any promotional material including advertising, brochures, publications, video productions, or any social media uses. I waive the right to any fee or compensation for either the use or reproduction of the resulting photographs in any medium. I understand these materials may be used by the BSHOP.
Certification*
I hereby accept the terms of this agreement and certify that all information in this application is accurate to the best of my knowledge.
Certification and Release of Indemnity*
I accept.
By checking the box below, I hereby accept the terms of this agreement and certify that all information in this application is accurate to the best of my knowledge. By checking the box below I also hereby certify that to the best of my knowledge I am in a state of health sufficient for me to take part in any of the activities sponsored by BSM without jeopardizing my well-being. I am aware that when taking part in activities like this there may be risks and dangers which I will assume personal responsibility for and will release and agree to indemnify and hold harmless BSM, its officers and directors, employees, and any parties volunteering on behalf of BSM, from all actions, costs, expenses or damages of any kind growing out of or related to any activities or transportation to and from the activities.

Step 1 of 5

Privacy

General Info

Short Answer Questions

Interest & Availability

Screening and Background Information

Medical Information

Reference

Reference #2

Reference #3

Almost done!

Contact

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