Volunteer Application

I hereby grant Meals on Wheels Programs & Services of Rockland (the “Organization” or “Meals on Wheels”) permission to use my
photograph in conjunction with my name for reproduction in advertising, display, or editorial use.

I understand that I volunteer at my own risk and should I be injured or become ill in the course of volunteering; Meals on Wheels DOES
NOT provide medical coverage. Workers compensation does not apply. I understand and agree that should I be asked to perform a task
that I am not comfortable performing, for whatever reason, that I do not have to perform such task and will inform my volunteer supervisor
of that decision.

I understand that I volunteer at my own risk and should I have an auto accident in the course of volunteering with the Meals on Wheels
Programs & Services of Rockland, that the Organization DOES NOT provide auto insurance coverage to volunteers. All homebound
drivers must provide a current proof of automobile insurance before they will be permitted to drive in the course of their volunteer service

I also understand that during the course of acting as a Meals on Wheels volunteer, I may learn certain information, including but not
limited to the nature of the disability suffered by a meal recipient. I understand that such information is strictly confidential and that I will
not disclose this information to any person or entity.

I give permission to Meals on Wheels to perform a criminal background check for the purposes of verifying my eligibility to volunteer to
serve an elderly population. It is understood that my personal information will be kept confidential and secure and will not be used for any
marketing purposes or shared with a third party without my permission.
Volunteers who have direct contact with Meals on Wheels program participants are required to complete a criminal background check for
sexual molestation charges. The purpose of this form and pass is to collect the information needed to perform a criminal background
check as required by our insurance carrier for our general liability insurance policy.

I understand that service hours are strictly for volunteering purposes and that all hours performed at Meals and Wheels will be without
compensation or pay. I further understand that my volunteer service with Meals on Wheels is “at-will” meaning that I may stop my
volunteer service with Meals on Wheels at any time and for any reason and Meals and Wheels may ask me to stop performing volunteer
services for Meals on Wheels at any time and for any reason.

I understand that only approved volunteers are allowed to participate for Meals on Wheels Programs & Services. All participants 12 and
older must have an approved volunteer application on file.