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NourishPHX

NourishPHX Volunteer Application



STOP! This is a one-time volunteer application. If you have already filled an application out, you do not need to fill this out again. Go back to the volunteer opportunities page and select the month you want to volunteer for.

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Your information


Required fields are marked with an asterisk (*).
First Name *
Last Name *
Address *
City *
State *
Zip Code *
Telephone Number *
Birthdate *

A valid date as MM/DD/YYYY (for example: 11/30/2015)
Emergency Contact Name *
Emergency Contact Phone Number *
How did you hear about NourishPHX?
Are you a court ordered volunteer? *
For court ordered volunteers:
If you are a court ordered volunteer, please do not complete this application. Instead, contact Francisco Lopez at 602.775.5741 or at francisco@nourishphx.org
Please note: All community service hours must be completed between the hours of 7:30am-2:30PM, Monday- Friday.
Physical Limitations *
If yes, please explain:
General Availability






Mark Your Areas of Interest




Skills
Why Do You Want to Volunteer at NourishPHX?
Would You Like to Receive the NourishPHX Newsletter? *
How many years have you volunteered for NourishPHX (previously known as ICM)?

Waiver

WAIVER: As a volunteer at NourishPHX, I hereby agree:
Assumption of Risk and Waiver of Liability: I acknowledge that I have voluntarily applied to volunteer with NourishPHX. I understand that the scope of my volunteer relationship with NourishPHX is limited to a volunteer position; that NourishPHX will not provide any benefits traditionally associated with employment; and that I am responsible for my own insurance coverage in the event of illness or personal injury as a result of my services with NourishPHX. NourishPHX also has volunteer insurance coverage.
I grant NourishPHX full permission to use videos, photographs and/or stories by me or by our organization for promotional purposes.
Children 14 years old or younger will not be allowed to volunteer without parental supervision, and children under the age of 18 will not be allowed to operate equipment. I will supervise my minor children during the time we are working at NourishPHX as volunteers, and assume responsibility for their safety, supervision and actions.
I understand that my volunteer activities with NourishPHX may include activities that could be hazardous to me, including but not limited to packing, loading, unloading and carrying heavy items. I fully understand and appreciate the risks that are inherent to my volunteer activities and I understand that I may decline to participate in any activity or task for which I do not wish to assume the risk. I hereby assume the risk of bodily injury, illness, death, medical treatment and property damage resulting from my volunteer activities, even if resulting from the negligence of NourishPHX or its directors or employees. I hereby release, discharge and agree to indemnify and hold NourishPHX harmless from, and waive on behalf of myself and my heirs and personal representatives and any minors I am responsible for who volunteer with me, any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act of NourishPHX, or that may otherwise arise in any way in connection with any voluntary activities with, or for NourishPHX. This liability waiver and release extends to NourishPHX together with all of its officers, directors, affiliates, employees and agents.

Signature of Volunteer



A Helping Hand Up From Poverty

Serving Your Local Area

Address

501 S 9th Avenue
Phoenix, AZ 85007

Mailing Address:

PO Box 2225
Phoenix, AZ 85002

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Food & Clothing Room Hours:

Mon – Fri 9 am – 11 am

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