Volunteer Application Today's Date Date Format: MM slash DD slash YYYY Please Select Volunteer Preference* Select All Extended Learning Academy (ELA) Green Leaf Learning Farm (GLLF) Universal Parenting Place (UPP) Family Stability Initiative (FSI) Day(s) Available to Volunteer* Select All Monday Tuesday Wednesday Thursday Friday Saturday Hours Available to Work (Open Monday through Friday, 9:00a.m. to 6:00p.m.)*(Minimum of 3 Hours/Week for 3 Months) Voulnteer start Date* Date Format: MM slash DD slash YYYY When would you like to start volunteering?Volunteer End Date* Date Format: MM slash DD slash YYYY When would you like to end your volunteer service? Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Alt PhoneWhy are you volunteering with us?*Please List Any Special Skills:*(Proficiency in PowerPoint/Excel, Social Media, Video, etc.)Do you speak more than one language? If yes, please specify*Do you have any medical limitations, food allergies, etc? If yes please specify.*Emergency Contact Name* First Last Emergency Contact Phone Number*How did you hear about us?*VOLUNTEER AGREEMENTPlease initial next to each box to give your consent.Confidentiality* I agree to the statement belowAny information provided about the clients of Knowledge Quest is to be kept in the strictest of confidences. None of the information exchanged about individuals, organizations or client cases will be discussed or shared outside of my official responsibilities with Knowledge Quest. Photo Release* I agree to the statement belowI understand that promotional pictures (individual and group) may be taken during volunteer hours. I give permission for my photo to be taken and potentially used in Knowledge Quest promotion materials.Medical Release* I agree to the statement belowI authorize treatment by a licensed medical physician or licensed medical team in case of any accident or illness that may arise in connection with execution of volunteering, as well as any necessary hospitalization.Consent & Liability Waiver* I agree to the statement belowI do hereby release, hold harmless, and discharge Knowledge Quest, its staff and volunteers from any and all liability, claim, loss, damage, cost or expense arising from my volunteering. I waive such claims against the organization that might arise directly or indirectly from any action or omission to act by the organization or persons in connection with volunteering unless the parties involved were careless or negligent.Consent for Criminal Background Check* I agree to the statement belowI agree to permit an investigation of my criminal background (CORI), for the purpose of volunteering at Knowledge Quest.Consent* I agree I'm over 18 and all of the information above is accurate and correct. This iframe contains the logic required to handle Ajax powered Gravity Forms.