1088 Fairfield Avenue — Bridgeport, CT 06605
(203) 333-4087
 

Ways to Get Involved - Volunteer

Individual Volunteer Application



General Information
Name
Date of Birth
Email address
Daytime Phone
Evening Phone
Cell Phone (optional)
Mailing Address
City, State, Zip
Emergency Contact
Emergency Contact Phone
Are you under 18?

Volunteers under 18 must have a parent or guardian complete and mail/fax in the Parental Approval Form

 

Reference


Please list one non-relative who lives locally and knows you well.

First and Last Name

Relation to you

Daytime Phone

Evening Phone

Mailing Address

City, State, Zip
Email Address

 

Security Information

Your response to any of these security questions will not automatically disqualify you from volunteering. However, if you answer "no" and a criminal history is found or if you answer "yes" but did not include all convictions you will be disqualified from consideration.

Have you ever been convicted (pleaded guilty or been found guilty) of a misdemeanor or felony? List any and all convictions and provide dates of each. (Including, but not limited to, major traffic violations, writing bad checks and DWI)

YES NO

 

Volunteer Interests

Please identify the areas of service in which you have an interest and/or expertise:


Please indicate any additional skills, talents or training you have that may be of use in your volunteer service. If you would like to serve as a tutor, please note the subjects you are willing to teach. If you are a medical professional, please note your license number and expiration date:


Time Availability
Sun Mon Tues Wed Thur Fri Sat
Morning
Afternoon
Evening
 
Do you attend a local church? Yes
No

If yes, name of church:

Pastor's name:

Phone number:



Terms of Agreement

Indemnity and Hold Harmless Agreement
The undersigned hereby agrees that the Bridgeport Rescue Mission is not responsible or liable for any and all claims, suits, causes of action and liability arising out of any claims, suits, causes of action of any kind which the undersigned or his/her child may have from now henceforward arising out of any actions, activities or events sponsored by the Bridgeport Rescue Mission. This agreement extends to any acts and/or omissions engaged in, by or attributable to any person or entity, including any agent, employee, volunteer or board member of the Bridgeport Rescue Mission. I also understand and agree that I may be asked to end my volunteer service at any time, for any reason, with sufficient notice. I will respect the confidentiality of all client information available to me through my position and maintain a professional relationship with all the Bridgeport Rescue Mission staff and resident/clients while I am a volunteer with the organization.

Volunteer Agreement
I acknowledge my understanding that the Bridgeport Rescue Mission is engaged in the practice of ministry and that, within the context of that ministry, I am volunteering to perform work duties without any expectation that I will be paid wages or any other type of compensation. I declare I am serving as a volunteer and not an employee. I hereby also affirm the information I have provided on this application is correct and do authorize the Bridgeport Rescue Mission to contact my references listed, to perform a background check and to secure a copy of a report from the local police, if necessary. If I am new to the area, another police department may be consulted.

Volunteer Guidelines
I acknowledge I have read the “Volunteer Guidelines.” I understand I am responsible for the information contained within that document, and by clicking “submit,” I agree to the terms and conditions set forth by this document. I have read all of the above information in full and am in agreement.