Volunteer Application

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Name

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Email

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Primary Phone

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Primary Address

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Emergency Contact

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Birthdate

About You

Why are you interested in volunteering with the Alzheimer's Association at this time?

What do you hope to gain from your volunteer experience?

Briefly describe any additional community involvement (professional, social, religious, civic, etc):

Skills and Interests

Current Workplace

Education

Please include your highest form of education

Availability

 MorningAfternoonEvening
Mon
Tue
Wed
Thu
Fri
Sat
Sun

References

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Reference Contact Information

Please provide at least 1 professional and/or personal reference

Seconday Reference Conatct Information

Volunteer Agreement and Release

In accordance with Chapter 43.43 RCW, prospective volunteers are asked to authorize the Alzheimer's Association to perform a Washington State Patrol Request for Criminal History Information background check.

Answer YES or NO to each of the following, if yes please explain below
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(1) Have you been convicted of any crime?

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(2) Have you had findings made against you in any civil adjudicative proceeding?

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(3) Have you had both a conviction and findings made against you?

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Release of Liability and Background Check Agreement

The Alzheimer’s Association, Washington State Chapter, accepts no liability for injuries or losses incurred by volunteers. I understand and acknowledge that this release discharges from any liability or claim that I may have with respect to bodily injury, personal injury, illness, death, or property damage that may result from the services I am providing.

I have read the information contained in this application. I understand that this is an application for a volunteer position with the Alzheimer’s Association, Washington State Chapter for which there is no monetary compensation. Placement of any person seeking to volunteer is not guaranteed. Volunteers are selected based on their qualifications in relation to the needs of the Association. In the selection of volunteers, there shall be no discrimination on the basis of race, gender, religion, disability, sexual orientation, age or any other basis prohibited by federal, state, or local law.

I certify under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. I authorize the Alzheimer's Association to conduct a background check at any time and to obtain any and all information needed to process my volunteer application. I understand the outcome of any Washington State background check is available to me upon request. I further authorize any person contacted by the Alzheimer's Association to provide information about my volunteer application. I understand that information from references will not be made available to me. I hereby release and hold harmless the Alzheimer's Association and all references from any and all liability in obtaining such information about my background. I understand that the Alzheimer's Association may, at its discretion, exclude me from volunteering for any reason at any time, including any misleading or incomplete statements on this application.
About AlzWA
To eliminate Alzheimer’s disease through the advancement of research; to provide and enhance care and support for all affected; and to reduce the risk of dementia through the promotion of brain health.
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