Online Volunteer Form and Agreement The mission of the Seneca County House of Concern is to help those in need with basic needs such as food, clothes and household items and to treat everyone with dignity and respect.Name * Email * Address *Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiComorosCongo (Brazzaville)CongoCosta RicaCote d\'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepaNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamYemenZambiaZimbabweCountry Phone * Preferred Method of Contact PhoneTextEmail It is required to have at least one emergency contact on file to contact in case of an emergency. Emergency Contact * Emergency Contact Phone * Emergency Contact * Emergency Contact Phone * Please share any special areas of expertise or experience that you bring to the House of Concern. Please list any limitations that you may have (ability to lift, walk long distances, etc.). When are you available to volunteer (please check any times)? *Monday 8 am - 12 pmMonday 12 pm - 4 pmTuesday 8 am - 12 pmTuesday 12 am - 4 pmWednesday 8 am - 12 pmWednesday 12 am - 4 pmThursday 8 am - 12 pmThursday 12 am - 4 pmFriday 8 am - 12 pmFriday 12 am - 4 pmSpecial Events WeekdaySpecial Events Weekend Please list specific times of availability if necessary May we contact you last minute if the need arises for a volunteer? *YesNo Volunteer Partnership Agreement The mission of the Seneca County House of Concern is to help those in need with basic needs such as food, clothes and household items and to treat everyone with dignity and respect. As a volunteer of the Seneca County House of Concern, I understand and agree to the following: 1. I will not be compensated by the Seneca County House of Concern – monetarily or through goods and favors – for any time spent volunteering. 2. I will report to the assigned manager upon arrival and prior to departure. 3. I will complete tasks as assigned. My assignment(s) will be determined by Seneca County Houseof Concern staff and may change depending on the needs of the program. 4. I will adhere to the general rules and expectations as outlined in the Employee Code of Conduct. If at any time I have questions or concerns regarding specific tasks or duties, general rules and expectations or my role as a volunteer, I understand that I may contact my manager for clarification.In consideration of my desire to serve as a volunteer for the Seneca County House of Concern, I hereby assume all responsibility for any and all risk of property damage or bodily injury that I may sustain while participating in any voluntary tasks or duties or other activity of any nature including the use of equipment and facilities of the Seneca County House of Concern. Further, I, for myself and my heir, executors, administrators and assigns, hereby release, waive and discharge the Seneca County House of Concern and its officers, directors, employees, agents and volunteers of and from any and all claims which I or my heirs, administrators and assigns ever may have against any of the above for, on account of, by reason of or arising in connection with such volunteer activities or my participation therein, and hereby waive all such claims, demands and causes of action. Further, I expressly agree that this release, waiver and indemnity agreement is intended to be as broad and inclusive as permitted by the State of New York, and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. I currently have no known, undisclosed mental or physical condition that would impair my capability for full participation as intended or expected of me. Further, I have carefully read the foregoing release and indemnification and understand the contents thereof and sign this release as my own, free act. Signature *By typing my name here I am expressing my acceptance of the above agreement Date VerificationPlease verify that you are not a robot. * This box is for spam protection - please leave it blank