Please list any allergies that should be taken into consideration.
List any special considerations for your placement (distance from home, preference for age or gender of Chore recipient)
General interests, skills, and languages spoken:
I will not let volunteering interfere with....I am concerned about....
Time and Day Availability
Please list the time you're available each day of the week, e.g. 8:30AM-10:00AM, 3PM-5PM
Please list three persons we may contact. You may include employers, teachers, religious leaders and personal friends. References remain confidential.
*I understand that as a volunteer of the Volunteer Chore Program I am a representative of VCP and will treat all clients and other volunteers with respect. I understand that while I may become friends with a client I help, that relationship has certain boundaries and I will honor those boundaries, including: staying out of my client’s legal matters, not accepting gifts from clients or giving them gifts (unless approved by VCP staff) and not accepting personal items for use from a client, like house keys, vehicle, etc.
(*This is for a volunteer’s protection as well as our clients’ protection.)
Client Confidentiality Policy - PLEASE READ CAREFULLY
Policy: Personal information about a chore client may not be disclosed by any person or
organization without the informed consent of the client.
Exception: The Volunteer Chore Program may disclose information to the Area Agency on Aging (AAA) or Department of Social and Health Services (DSHS) for purposes directly connected with the administration of their programs. Such purposes include but are not limited to: determining eligibility, providing a service to resolve client complaints, and participating in an audit.
Exception: The Volunteer Chore Program may disclose information for research, statistical, monitoring, or evaluation purposes conducted by appropriate federal agencies and DSHS. Other entities to which information may be disclosed for the preceding purposes are those agents authorized by DSHS in writing, including AAA’s and organizations and/or individuals under contract to the department.
These exceptions do not apply when federal and/or state regulations for a particular program require that informed consent be obtained.
Unless the situation is covered by the above exceptions, personal information may not be released without the informed consent of the client or his/her guardians. To meet the requirements of informed consent, the client or his/her guardian must be fully apprised of:
1. The voluntary nature of the disclosure.
2. The nature and extent of the information being released.
3. The person or organization to whom the information will be released.
4. The purposes for which the information will be used.
5. The effect, if any, on the subject, of not providing all or part of the requested information.
6. Any other facts which, under the circumstances, are necessary to the giving of intelligent
A written release must be used.
All staff (paid or unpaid) of the Volunteer Chore Program, and its’ host agency, The Volunteer Center of Whatcom County/Opportunity Council, are bound to the above policy. Program clients act in good faith, expecting their circumstances and personal matters to remain confidential, and we are obligated by law and ethics to reciprocate.
Subject to the policy and exceptions noted within this document, the following guidelines have been established in the matter of confidentiality:
1. Information and details about name-specific client situations may be discussed for program purposes only, i.e. case may be discussed in staff and supervisory meetings in order that service may be more appropriately managed.
2. The file records that are kept on clients should be used only for program purposes. Other agencies requesting the records of given clients should first obtain releases of information from the client. In no case should the records be automatically sent to another person or agency without first receiving a release of information from the client or their legal guardian.
3. Discussing the details of a client outside the program, even though names and addresses are not revealed, could also be considered a breach of confidentiality. That is, one might possibly describe in detail facts about the client and never mention who the person is or allude in any way to names or type of descriptive data, and yet, within the description, reveal enough that the listener might possibly identify the client. If client examples are used for illustrative purposes, care must be taken in sufficiently altering the circumstances of the example to assure that client confidentiality is maintained.
4. The fact that a client situation has been made public by other means (including the news media) does not alter the fact that this person still has confidentiality privileges within the program itself.
The following oath will be signed by each staff (paid and unpaid) of the Volunteer Center of Whatcom County/Opportunity Council and by each staff (paid and unpaid) of the Volunteer Chore Program. This form will be retained in the office of the Volunteer Center of Whatcom County/Opportunity Council.
BY SIGNING BELOW I UNDERSTAND AND AGREE TO THE ABOVE POLICY AND AM AWARE THAT ANY BREACH OF CONFIDENTIALITY IS GROUNDS FOR IMMEDIATE ACTION BY MY SUPERVISOR.
I attest that I have read the foregoing, and the facts alleged are true to the best of my knowledge and belief.
To the best of my knowledge and belief, my record may contain one or more of the foregoing disqualifying acts or offenses.
Photo ID and Insurance Card
This is required -
If you're unable to upload a picture please contact us to proceed with the application process.
Required if using your vehicle for volunteering purposes.