Boys & Girls Club
With Kroc Center Greenville

The Salvation Army North & South Carolina Division

Safe From Harm Volunteer Application

This form is designed for Applicants requesting to volunteer in any position involving minors. This application is used to help promote a safe environment for the children and youth who participate in our programs or use our facilities. Please include all information requested. Answer questions to the best of your ability. All information will be treated confidentially.
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Name

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Email

Please provide any other name that may have used as a volunteer or employee. (Such as maiden, nickname, etc.

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Primary Address

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Primary Phone

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What type of volunteering are you interested in?

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Gender

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Birthdate

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Age

If you are a student, what school do you attend?

If you are a member of a church, please tell us the name of your church and provide your church's address.

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Skills

Please select all skills that you possess.

Please list any other skills or training that you feel has prepared you for the area that you wish to volunteer.

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How did you hear about us?

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Availability

 MorningAfternoonEvening
Mon
Tue
Wed
Thu
Fri
Sat
Sun
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Terms and Conditions

The Salvation Army has adopted the guidelines and policies of Safe From Harm. If approved, you will be trained on these policies. Do you agree to observe all guidelines and policies regarding working with youth?
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Current Workplace

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How long have been employed at the above organization?

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Please indicate any other places that you have worked? Please provide contact information.

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Please indicate any other places in which you volunteered or were employed in which you were specifically involved with youth in the last 5 years. Please provide the nature of your work and any contact information for the organization.

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Have you ever been subjected to expulsion, reprimand, or other discipline by an organization for abuse or misconduct involving a minor?

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Have you ever been disciplined or dismissed from employment or a volunteer opportunity following an allegation of sexual misconduct, sexual harassment, or other inappropriate behavior or conduct?

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Have you been the subject of a complaint or disciplinary proceedings against a license held by you?

Please explain any yes answers to the three questions above.

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Felony Charges Information

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Misdemeanor Charges

Please explain any felony or misdemeanor charges.

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Terms and Conditions

To volunteer with minors at The Salvation Army, you must provide authorization to initiate a background check. If you are willing to give permission, please check below. A separate form with actual authorization will be emailed to you.

If interested in homework or tutoring, please indicate preferred subject areas.

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If intending to work with youth, what age group do you prefer?

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Are you connected to The Salvation Army

Please explain your connection to The Salvation Army.

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Terms and Conditions

I understand and agree that it is critical to the mission and ministry of The Salvation Army that all volunteers conform to the highest standards of safety, interpersonal conduct, and sexual morality. I affirm that I will strictly comply with The Salvation Army's policies and procedures, including those concerning child safety and protection, sexual abuse and misconduct, and interpersonal relationships. I understand and agree that failure by me to abide by such policies and procedures may result in my immediate dismissal from volunteering within the discretion of The Salvation Army.

References - Please provide 4 that are not related to you.

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Reference #1

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Reference #1 Phone Number

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Reference #1 Relationship to you

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Reference #2

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Reference #2 Phone Number

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Reference #2 Relationship to you

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Reference #3

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Reference #3 Phone Number

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Reference #3 Relationship to you

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Reference #4

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Reference #4 Phone Number

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Reference #4 Relationship to you

Please include any other information that you think would be helpful to us in determining your ability as a volunteer.

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Terms and Conditions

I certify that the information contained in this application is true and complete. I authorize investigation of all statements or material omissions are cause for my inability to volunteer on behalf of The Salvation Army. I hereby authorize former and present employers/volunteer organizations, except as I have otherwise indicated on this application, references and other sources to provide or verify any information that they may have regarding me, my employment and/or volunteer service with them to The Salvation Army and release them from any liability arising from the furnishing of any employment/volunteer information.

I understand I will not receive any monetary compensation as a result of volunteer activities performed on behalf of The Salvation Army.

I further certify that I recognize that The Salvation Army is a church and agree that I will do nothing to undermine its religious mission.
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Release/Waiver

I release and forever discharge and hold harmless The Salvation Army from any claim or liability that I may have against The Salvation Army with respect to any bodily injury, personal injury, illness, death or property damage that may result from my participation in a volunteer opportunity. I also understand that The Salvation Army does not assume any responsibility or obligation to provide financial or other assistance, including, but not limited to medical, health, or disability insurance, in the event of injury, illness, death or property damage.

I understand that I should not volunteer for any task that I feel unsafe or uncomfortable with completing.
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Media Authorization

I hereby irrevocably grant to The Salvation Army, its successors and assigns, its agents and those whom it is commissioned, the absolute, unrestricted and unlimited license, right, permission, and consent to use and reuse, disseminate, copyright, print, reproduce, publish and republish, for any and all trade purposes or commercial or other advertising or public purposes, and in any and all advertising or other advertising or public purposes, and in any and all advertising, publicity. Display, publication or media, my name, signature and likeness, and any portraits, pictures, photographic prints or other representations of me, or in which I may appear, or any reproductions or sketches thereof or parts thereof, photographic or otherwise, with such additions, deletions, alterations or changes therein as you in your discretion may make, either separately or together with my name or a fictitious name, or the name of another person, with or without any statements or testimonials made by me, or authorized by me which you may, in your discretion, prepare for use in connection therewith.
About Kroc Center Greenville
The Kroc Center of Greenville is a community based center dedicated to the involvement of the needs of the people throughout the community. The Kroc is dedicated to recreation, education, and worship for members of all ages and backgrounds.
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Kroc Center Greenville
424 Westfield Street
Greenville
South Carolina
United States