First and Last Name
* First and Last Name
Please tell us why you are interested in helping with this ministry?
How did you hear about us?
Are you part of a small group?
If yes, what church or organization?
Emergency Contact Name:
Emergency Contact Name:
Emergency Contact Number:
* Emergency Contact Number:
Personal Reference (not related to you)
* Personal Reference (not related to you)
Personal Reference Phone Number
* Personal Reference Phone Number
Personal Reference Email
Professional Reference (not related to you)
* Professional Reference (not related to you)
Professional Reference Phone Number
* Professional Reference Phone Number
Professional Reference Email
Information Regarding Criminal Past:
Have you ever been accused of and/or convicted of a felony? If so, what were the circumstances? Would there be something that might come up on your background check you would like to explain?
Release and Waiver of Liability
By checking this box you agree to all of the following: In consideration of the participation of helping Single MOMM, (SMOMM), the undersigned (volunteer). Hereby agrees to donate and offer his/her personal services and labor, free of charge, to Single MOMM. Volunteer understands and agrees that they are not an employee of SMOMM and are not entitled to any wages and/or benefits associated with their services. Volunteer acknowledges and understands that the activities include work that may be hazardous to the Volunteer, including but not limited to, construction, loading and unloading, and transportation to and from any venue,/work sites. Volunteer further agrees, on behalf of himself/herself and on behalf of his/her heirs, assigns, trustees, receivers, administrators, executors and agents to release and forever discharge SMOMM, their directors, officers, employees, agents, volunteers, invitees, sponsors, cash donors, in-kind donors, and all other personas or entities whomsoever (SMOMM), of and from any and all actions, claims, and demands, known or unknown, which Volunteer has or may have in the future arising out of volunteering for SMOMM. Additionally, Volunteer specifically releases any subrogation rights that might arise. Volunteer understands that this Release discharges SMOMM for any liability or claim that the Volunteer may have against SMOMM with respect to any bodily injury, personal injury, illness, death or property damage that may result from Volunteers activities with SMOMM whether caused by the negligence of SMOMM or its officers, directors, employees, or agents or otherwise. Volunteerunderstands that SMOMM does not assume any responsibility for or obligation to provide financial assistance or other assistance, including but not limited to medical, health, or disability insurance in the event of injury or illness. Volunteer does hereby grant and convey unto SMOMM all right, title and interest in any and all photographic images and video or audio recordings made by SMOMM during the Volunteers’ work for SMOMM including, but not limited to, any royalties, proceeds, or other benefits derived from such photographs or recordings. The undersigned acknowledges that he/she has read this Release and understands that this Release may be pled as a complete bar and defense to any action or other proceedings instituted or filed by Volunteer on account of any matter contained herein. Volunteer expressly agrees that this Release is intended to be as broad and inclusive as permitted by the lows of Michigan and that this Release shall be governed by and interpreted in accordance with the laws of Michigan. Volunteer agrees that in the event that any clause or provision of this Release shall be held to be invalid by any court of competent jurisdiction, the invalidity of such clause or provision shall not otherwise affect the remaining provisions of this Release which shall continue to be enforceable. I authorize, at Single Mom Ministry’s discretion, investigation of all statements made by me in this application, and review of any civil or criminal records which may exist, concerning me, except for such records as are sealed according to state or federal law. I further authorize SMOMM at its discretion, to contact references and others whose names are provided on this application form, or whose names, may be identified by me in an interview, and I authorize such persons to provide SMOMM with information requested by SMOMM regarding me. I further release any such individuals, as well as SMOMM for any claims I might have arising out of any discussions involving me, or the provision of any information or records regarding me Volunteer Responsibility. If for any reason I believe that my working as a volunteer for SMOMM might endanger myself or others or I have knowledge of or suspect any dishonest, deceptive, illegal or unethical activities, I must report this to the Executive Director immediately at the site, and the SMOMM employee overseeing the volunteer activity. This might include, among other things, improper use of agency property, communicable diseases, physical impairments, and medication (prescription and/or otherwise that might impair my judgment). I am volunteering for SMOMM at my own risk.
Please send a photo of the front and back of your Driver's License or Sate ID to:
MAIL: PO Box 2442, Traverse City MI 49685 EMAIL: email@example.com
*We must have a photo of your ID before you can be considered to volunteer with Single MOMM