Organization Volunteer Form Organization Volunteer Sign Up NOTE: In the event that volunteers would have direct contact with individuals served by The Arc, then The Arc will be required to perform background checks. First Name*Last Name*Group Name*Organization*Organization Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone Number*Email Address (work or personal)*Emergency Contact Name, Relationship and Phone Number*How did you hear about this opportunity?*Please provide the First and Last Names of all volunteers in your group*Authorization to Release Information*On behalf of my group, I authorize The Arc of the Quad Cities Area to use, reproduce and/or publish my image, likeness without compensation. I understand that this material could be used in The Arc’s publications. Yes No Commitment to Confidentiality*I agree to The Arc of the Quad Cities Area’s commitment to confidentiality. I am not authorized to take pictures of individuals served by The Arc and will follow confidentiality policies and procedures. If for some reason, these policies cannot be followed, The Arc reserved the right to terminate this agreement. I Agree Injury Release*I recognize this is a voluntary assignment with no compensation. I hold harmless The Arc of the Quad Cities Area from any injury sustained in my volunteer assignment. Yes PLEASE READ*The confidential information on this form will help determine the most satisfying and appropriate volunteer service for you. This form does not commit you to volunteering for The Arc of the Quad Cities Area. I Understand I CERTIFY THAT TO THE BEST OF MY ABILITY THAT THE INFORMATION PROVIDED ON THIS APPLICATION IS TRUE AND ACCURATE.*I understand that typing my name in the following field acts as my signature for the form.