Aug
29
Atlanta Black Pride 2019
With Atlanta Black Pride, Inc.

Atlanta Black Pride Volunteer Application

PLEASE NOTE: All sections marked with * are required.
You may mark sections not applicable to you with N/A. A confirmation screen will pop up when you have successfully submitted your application. If you hit the SUBMIT button and do not see this screen, please review your application for any missing required fields, complete them, and hit SUBMIT again.
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Name

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Email

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Primary Address

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Primary Phone Number

Alternate Phone Number

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Birthdate

*Birthdate is requested in order to expedite our annual background checking process. If you are under 18, please note that an underage waiver must be signed by your parent or guardian prior to you volunteering.
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Are you at least 18 years of age or older?

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Are you registering as a part of a group?

If yes, please enter the group name

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Have you ever been convicted of a felony?

If yes, please explain

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Are you able to lift 20 lbs or more?

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How did you hear about us?

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Emergency Contact

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Authorization

I certify that the answers given in this application are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application as may be necessary for the purposes of determining an appropriate and satisfactory volunteer position for me. I understand that this application is not, and is not intended to be, a contract. I understand that false or misleading information provided in my application or interview may result in my not being able to continue as a volunteer with Atlanta Black Pride, Inc.
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Confidentiality Agreement

In signing this agreement, I acknowledge that I have read and understood Atlanta Black Pride’s confidentiality policies. I understand and agree that in the performance of my duties as an employee or volunteer of Atlanta Black Pride, I must hold certain information regarding clients, employees and volunteers in the strictest confidence. Further, I understand that confidentiality is protected by Federal law (42CF R Part II and Uniform Health Care Information Act) and that any intentional or involuntary violation of the confidentiality with regard to clients, employees and/or volunteers may result in disciplinary action including suspension and/or termination. A complete copy of Atlanta Black Pride's Confidentiality Policy can be requested from the Volunteer Coordinator.
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Liability Release

I hereby release, indemnify and hold harmless Atlanta Black Pride, its officers, directors and employees, and the organizers, sponsors, and supervisors of all Atlanta Black Pride activities from any and all liability in connection with any injury I may sustain (including any injury caused by negligence) in conjunction with volunteering with Atlanta Black Pride.
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Media Release

In signing below, I agree to be photographed, videotaped and/or recorded by Atlanta Black Pride while participating in the volunteering with Atlanta Black Pride. I understand that Atlanta Black Pride will own rights to and may use this media (photographs, videotape, recordings and/or my statements), in whole or part, in Atlanta Black Pride materials such as printed publications, Atlanta Black Pride website (www.atlantablackpride.org), videos, social media, grant proposals and promotional materials to support Atlanta Black Pride and its programs. As far as I know, what I say and do in this media will not violate the rights of any other person or company. If I no longer want my photos and/or story to be used, I agree to contact the Atlanta Black Pride Communications Department at publications@atlantablackpride.org or 678.946.2070. Once requested, Atlanta Black Pride will not create new materials using participants’ media – but we may continue to use already printed materials until we can make replacements.
Event Details
Thursday 29 August 2019, 7am–3 September 12am EDT
Georgia Tech Hotel and Conference Center, Atlanta
About Atlanta Black Pride, Inc.
To educate, celebrate, promote self-empowerment and to ensure that the social and cultural needs of LGBTQ+ individuals and families are met throughout the Atlanta Metropolitan area.
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