August Pop-Up Care Village ~ City Slicker Farms in West Oakland
With LavaMaeˣ

Pop-Up Care Village Volunteer Sign-Up Form






Primary Phone



Do you speak languages other than English?

If other, what language(s) do you speak that are not listed above?

Primary Address

Current Workplace


T-shirt Size


Have you volunteered at a Pop-Up Care Village before?


COVID-19 Vaccination + Mask Policy

The safety of our guests, staff, and volunteers are top priority. I agree that I am fully vaccinated from COVID-19, and that I will follow LavaMaeX's mask requirement during the duration of my shift (except for eating and drinking). I understand that failure to follow these guidelines will jeopardize any future involvement with LavaMaeX.

Volunteer Service Agreement

As a volunteer for LavaMaeX, a California nonprofit public benefit corporation, (“Lava Mae”), I understand and agree to the following:

I agree to perform volunteer services at LavaMaeX as more fully described in the attached Description of Volunteer Activity. My supervisor for the duration of my volunteer activity will be Scarlet Corona Ortega, Pop-Up Care Village Program Coordinator, LavaMaeX.

I agree to volunteer and donate my services, without expectation of payment, benefits, or other privileges of employment of any kind, to LavaMaeX. I am volunteering my services for public service and humanitarian objectives, which I agree constitutes good and valuable consideration. I understand that I am not, an employee, agent, or representative of LavaMaeX for any purpose and I will not speak on behalf of LavaMaeX or represent LavaMaeX to third parties unless authorized to do so. I understand and agree that either I or LavaMaeX may elect to terminate my volunteer services at any time for any reason.

Before beginning my volunteer work, I understand that I will be asked to certify my review and acceptance of LavaMaeX’s Release and Waiver of Liability, Workplace Harassment Prevention and Reporting, Media Release Policy, and Confidential Information – Protection and Use. I understand that I will be bound by such policies and procedures. My supervisor for the duration of my volunteer activity will be responsible for advising me as to which LavaMaeX policies and procedures specifically apply to my volunteer work.

With regard to my presence on LavaMaeX property or the location at which the event is held (if different than LavaMaeX property) and the volunteer services I will be providing, I recognize and acknowledge that there are certain risks of physical injury, and I agree to assume the full risk of any bodily injuries, property damage, or loss, which I may sustain as a result of participating in any and all activities connected with or associated with my volunteering for LavaMaeX. I agree to sign the attached form entitled “Release and Waiver of Responsibility” form.

In the event of an emergency, I authorize LavaMaeX officials to secure from a licensed hospital, physician and/or medical personnel any treatment deemed necessary for my immediate care, and I agree that I will be responsible for payment of all such medical services rendered.

I understand that LavaMaeX will retain the ownership of all intellectual property that I produce within the scope of my volunteer work and will reserve sole discretion to publish any intellectual product.

I understand that LavaMaeX will not reimburse for any expense without proper and adequate documentation and receipts and express prior approval, in writing, by my supervisor. Such expenses must be reasonable in amount, related to and in furtherance of my volunteer work.

This Agreement shall in all respects be interpreted, enforced, and governed by and under the laws of the state in which I am located for purposes of this assignment.

I certify that I have the ability and legal right to volunteer in the United States of America for the duration of this volunteer assignment without any restriction, and that I have chosen to accept this assignment on a completely volunteer basis. I have read and fully understand and agree with the terms of this Volunteer Agreement. I also understand that no changes shall be made to this document unless they are in writing and signed both by an authorized representative of LavaMaeX and by me.


In administering the Fair Labor Standards Act, the U.S. Department of Labor follows the Supreme Court’s guidance in the case of individuals serving as unpaid volunteers in various community services. Individuals who volunteer or donate their time for public service, religious or humanitarian objectives are not considered employees.

Volunteer responsibilities at LavaMaeX’s mini-PUCV may include:

  • Greet and engage with guests, including helping them navigate the space and become familiar with services offered throughout the day.

  • Conduct intake survey and check-in process with guests.

  • Collect data from our partners, working in a support role with service partners, managing guest intake lines and keeping partner areas clean and orderly.

  • Serve food to our guests, volunteers, and partners and keep the food service area neat and tidy.

  • Organize and fold clothes at our Street Store, act a shop keeper, supporting guests with finding clothes.

  • Conduct exit surveys for guests leaving the mini-PUCV

  • Generally support the entire event, including setting up site equipment and breaking down the site at the end of the day.

Guest Privacy & Media Agreement

I understand that collecting images, video, and audio of guests without their permission is a violation of LavaMaeX Deep Consent policy. Before collecting any media content of a LavaMaeX guest, I understand that I will first need to check-in with my volunteer supervisor to ensure they walk through the Deep Consent policy with the guest.

Failure to follow the Deep Consent protocol will jeopardize any future engagement with LavaMaeX

Media Release Agreement

I understand that my photos/videos/audio will be captured for the purpose of being used and distributed in various formats by LavaMaeX for educational, public awareness and/or humanitarian objectives, including, but not limited to, classroom, television, news media, Internet (including webcasts, content postings, and podcasts), and any other communication medium currently existing or later created.

I also grant permission to use my name.

I authorize ​LavaMae​X​ to edit, alter, share, remix, modify, build upon or in any way alter the photograph(s) mentioned above. LavaMaeX retains the right not to use any footage captured for other than archival purposes.

I also waive any rights of privacy or compensation associated with the use of my photos/videos/audio and name for the personal or commercial purposes outlined above.

I warrant and represent that I have carefully read this Release and any instructions provided by LavaMaeX concerning Volunteer Activities.

Release and Waiver of Responsibility

Liability Release and Waiver:

I have volunteered to assist LavaMaeX, a California nonprofit public benefit corporation (“Lava Mae”).

I have volunteered my time and services because of my support for LavaMaeX and my desire to participate actively in the furtherance of its work. For good and valuable consideration and in consideration of my participation in activities that can be dangerous, including, but not limited to: accidental injury from working in and around motorized vehicles used in the activities, altercations with or assault by intoxicated and/or mentally ill individuals, being injured or sickened from exposure to cleaning and disinfecting products which may contain chemicals known to be harmful, or from transmittal of viruses, bacteria or pests (like lice, bed bugs) which may remain on surfaces and/or items with which clients have come into contact, and emotional distress from seeing clients in poor conditions. I release LavaMaeX, its present and former members, agents, employees, officers, directors, shareholders, affiliates, parent corporations, subsidiaries, representatives, attorneys, successors in interest, predecessors in interest, and assigns (collectively, “LavaMaeX” or the “Releases”) for any and all claims for personal injury, property damage, or wrongful death arising out of or relating to any of my activities. Because the assertion of claims against LavaMaeX for personal injury occurring during my volunteer service would be antithetical to my support of LavaMaeX and its goals and would reduce the ability of LavaMaeX to accomplish its charitable purposes, I grant this release.

This Release and Waiver of Responsibility (“Release”) applies to any and all manner of actions and causes of actions, suits, debts, obligations, actions, contracts, covenants, warranties, claims, sums of money, judgments, demands, damages, and rights whatsoever in law or in equity, which have or may accrue in favor of myself against any one or more of the Releases, by reason of any facts or circumstances, known or unknown, suspected or unsuspected, or which may hereafter arise as a result of the discovery of new and/or additional facts, including, without limitation, those arising out of, on account of, based upon, or in any way relating to my activities. I expressly waive any and all benefits that would otherwise be available under any statute, legal decision, or common law principle with respect to unknown or suspected claims.

I shall defend, indemnify, and hold Releases harmless from any and all claims of any person or entity to the extent that such claims arise from or relate to my activities.

Confidential Information - Protection and Use Policy


Employees and volunteers will not divulge any confidential information to anyone, within or outside LavaMaeX, not authorized to receive such information. Confidential information is knowledge, records or data, in any form (written, electronic, or oral), which LavaMaeX has a legitimate interest in protecting from unauthorized disclosure. Examples include contents of project files; strategic plans; terms and conditions of contracts completed or under negotiation; donor information such as donor names, appraisals and giving histories; employee salaries; contents of official personnel files; and sensitive data.


To respect and assure the privacy of LavaMaeX employees, its donors, its partners, and its business associates.

Anti-Discrimination and Harassment Policy

LavaMaeX is committed to establishing and maintaining a work environment that fosters harmonious, productive working relationships and encourages mutual respect among colleagues.

LavaMaeX expressly prohibits any form of unlawful harassment based on race, color, creed, religion, national origin, ancestry, citizenship, sex, gender identity and expression, sexual orientation, age, marital or partnership status, disability, military or veteran status, genetic information, predisposition or carrier status, or status as a victim of domestic violence, sexual offense or any other class or status protected by law. Harassment may include slurs, epithets, threats, derogatory comments and unwelcome jokes, pranks, teasing, as well as physical conduct such as assault. Harassment is unlawful whether it involves co-worker harassment, harassment by a manager, or harassment by persons doing business with or for LavaMaeX.

Sexual Harassment

Sexual harassment is a form of misconduct that is demeaning to another person, undermines the integrity of the employment relationship, and is strictly prohibited.

Federal, state, and local law forbid sexual harassment of an individual in employment. The Equal Employment Opportunity Commission defines sexual harassment as follows:

Unwelcome sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature constitutes sexual harassment when (1) submission of such conduct is made either explicitly or implicitly a term or condition of an individual's employment; (2) submission to or rejection of such conduct is used as the basis for employment decisions affecting such individual; or (3) such conduct has the purpose and effect of unreasonably interfering with an individual's work performance or creating an intimidating, hostile or offensive working environment.

Sexual harassment may include explicit sexual propositions, suggestive or persistent comments of a sexual nature, the display of obscene or sexually-oriented material, sexually oriented kidding or teasing, or jokes about gender-specific traits, foul or obscene language or gestures, and physical contact such as patting, pinching, or brushing against another’s body, and any similar behavior which is unwelcome or offensive.

Resolving & Reporting Violations

Individuals who have encountered harassing behavior are encouraged to clearly and directly advise offenders that their behavior is unwelcome, and request that the behavior stop. This action alone may in some cases resolve the problem. If an individual does not feel comfortable approaching the offender, or if the behavior continues, the individual is encouraged to discuss the harassment, discrimination or retaliation with their volunteer manager or supervisor or, if this is not appropriate, with LavaMaeX Human Resources. Any manager or supervisor who becomes aware of possible unlawful behavior must immediately advise Human Resources so that the issue can be investigated in a timely manner.

Individuals should contact LavaMaeX directly when reporting violations, one should provide as complete a description as possible of the facts surrounding the incident(s) forming the basis for the complaint so that an appropriate investigation can be conducted.

LavaMaeX strongly urges the prompt reporting of complaints or concerns so that appropriate action can be taken as quickly as possible. LavaMaeX will investigate all complaints promptly and will maintain confidentiality throughout the process to the extent practicable and appropriate under the circumstances.


Retaliation against an individual for reporting discrimination or harassment or for providing information relevant to a claim of discrimination or harassment is strictly prohibited and will be treated with the same strict discipline as would discrimination or harassment itself. Individuals should immediately report acts of retaliation in accordance with the reporting procedures described above. These reports will be investigated promptly.

Contacting LavaMaeX

As is noted above, LavaMaeX employs a human resources specialist who manages employee relations. Please report any violations to the following individual:

Operations Manager
Adam Vera

Please verify that you are:


Emergency Contact

Event Details
Friday 27 August 2021, 10am-3pm PDT
City Slicker Farms, 2847 Peralta St
About LavaMaeˣ
LavaMaeˣ is a non-profit changing the way the world sees and served our unhoused neighbors.
Visit hub