Volunteer Application Volunteer Application For volunteer opportunities within the ministry please fill out our Volunteer Application. Volunteer Name First Last Email Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country PhoneCheck here if volunteer is under the age of 18 Yes, the volunteer is under the age of 18 Days Available Monday Tuesday Wednesday Thursday Friday Saturday Sunday Do you have any health limitations? Yes No If yes, please explain: Do you object to our agency running a background check on you? Yes No Section BreakEmergency Contact Name First Last Relationship to Volunteer Preferred Phone NumberI hereby certify that the aforementioned information are true and correct to the best of my knowledge. I hereby grant The Lighthouse permision to verify such answers. First Last Date MM slash DD slash YYYY Section BreakConfidentiality Statement: First Last In the normal course of my volunteer assignment, I understand that I may have access to or view information regarding clients and employees. I agree that knowledge and information of a confidential nature, gained through my involvement with The Lighthouse may not be used, distributed, or discussed outside my volunteer responsibilities. Section BreakThe Lighthouse Waiver & Release Agreement: This Waiver is by and between the volunteer identified on this application or said volunteer's parent(s) or guardian(s), and The Lighthouse, and each of its directors, officers, employees. In return for being allowed to participate in volunteer activities organized by The Lighthouse, I agree not to sue, and to release The Lighthouse from all present and future claims that I may make for property damage, personal injury, or wrongful death arising as a result of participating in the volunteer activities wherever, whenever, or however occurring. I understand and agree that The Lighthouse is not responsible for any injury or property damage arising out of the volunteer activities, even if caused by ordinary negligence. First Last By signing, I affirm that I am of legal age and I am freely signing this agreement.Date MM slash DD slash YYYY Signature of Volunteer's Parent/Legal Guardian (if younger than 18 years) First Last By signing, I affirm that I am the parent or legal guardian of the volunteer. I am of legal age and am freely signing this agreement.Date MM slash DD slash YYYY Section BreakThe Lighthouse Publicity Release Agreement: This publicity release agreement is by and between the volunteer identified and said volunteer's parent(s) or guardian(s), The Lighthouse, a nonprofit corporation organized and existing under the laws of the State of Indiana, and each of its subsidiaries, affiliates, agents, advertising or promtional agencies, and partners, and all such entities' officers, directors, agents, employees, and respective successors and assigns. In return for being allowed to participate in volunteer activities organized by The Lighthouse, including all related activities and activities incidental to such participation. I hereby grant The Lighthouse the absolute and irrevocable right and permission to use, publish, broadcast and/or copyright the use of my name, address, voice, photograph and/or likeness, caricature, and personal information, in its current form or as retouched, digitized, cropped, altered, distorted or modified in any way, in all advertising, promotional, or other materials based upon or delivered from The Lighthouse in any manner in any media whatsoever for any and all purposes, including by way of example but without limitation; advertising, promotion, or publicizing and services thorughout the universe, in perpetuity, in any and all media now known or hereafter devised, without compensation. I further agree that anything derived there from will be owned solely by The Lighthouse. I shall not authorize the use of any print, negative or other copy thereof by anyone other than The Lighthouse. I understand that this agreement is intended to be as broad and inclusive as permitted by the laws of the State of Indiana and agree that if any portion of this agreement is invalid, the remainder will remain in full force and effect. First Last By signing, I affirm that I am of legal age and I am freely signing this agreement.Date MM slash DD slash YYYY Signature of Volunteer's Parent/Legal Guardian (if younger than 18 years) First Last By signing, I affirm that I am the parent or legal guardian of the volunteer. I am of legal age and am freely signing this agreement.Date MM slash DD slash YYYY Δ