TTCG Volunteer – Time to Change Generations TTCG

TTCG Volunteer - Screening Form

Each person interested in volunteering in the program must complete this form. It will be used to help TTCG provide a safe environment for students.

GENERAL INFORMATION:

Full Name

D.O.B

Home Address

City

State

Zip Code

Home/Cell Phone #

LEGAL INFORMATION:

Have you ever been arrested, convicted, or pleaded guilty to a crime?

Yes No

(If yes, please explain)

Have you ever been suspected, accused, charged, or alleged to have, or have committed an act of neglecting, abusing or sexually abusing a minor?

Yes No

(If yes, please explain)

EXPERIENCE WORKING WITH MINORS – (Volunteer or Paid):

Type of Work

Place

Dates

BY SIGNING THIS FORM, I AGREE TO THE FOLLOWING:
The information contained in this form is true and correct to the best of my knowledge.
I have received, read, and understand the Time to Change Generations (TTCG) Guidelines and Policies for volunteers.
I have a PA Child Abuse Clearance Certificate and Criminal Background Certificate up to date.
I understand that the PA Child Abuse Clearance Certificate and Criminal Background Certificate are only acceptable for 5 years from the date issued. In the event that one or both Clearances need to be renewed, I take full responsibility for covering the expense(s) to obtain the new one(s).
I understand that it is my responsibility to update this form with changes to my personal information as they arise.
I currently have no known physical or mental condition that could impair my ability for the full participation provided or expected from me.
If any information I have provided is found to be false or misleading, I can no longer volunteer in the Time to Change Generations (TTCG) program.
I release Time to Change Generations (TTCG) and/or coordinators from any liability and liability for any claims whatsoever arising or may arise during and after my services.

I HAVE CAREFULLY READ THE AFOREMENTIONED AND KNOW ITS CONTENTS AND SIGN THIS FORM OF MY OWN FREE ACT.

SIGNATURE

DATE

This document constitutes a co-signature. If necessary, a signature must be made on the original printed document when you are at the Time To Change Generations offices.

TTCG Volunteer - Screening Form

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Time to Change Generations - © 2024 - Site Design by CProjects Network | All rights reserved

TTCG Volunteer - Screening Form

TAKE ACTION

navigate

Subscribe to our newsletter

We accept donations

Time to Change Generations - © 2024 - Site Design by CProjects Network | All rights reserved

Subscribe to our newsletter

WE ACEPPT DONATIONS