Volunteer Application

Please enter at least one phone number for your contact.

This section is optional. Due the health concerns for our volunteers, volunteers completing this form should be both at least age 18 and out of high school and no older than 67 years old. This section is only used to help us get a better idea of the demographic make-up of our volunteers.

NASP obtains arrest and conviction records on all potential volunteers. An arrest or conviction will not automatically eliminate you from consideration for volunteering. However, failure to list all pending charges and/or convictions may lead to your disqualification or termination of volunteering with NASP. Examples may include, but not limited to: driving while impaired, worthless checks, assault, driving while license is suspended, disorderly conduct, credit card fraud, embezzlement, etc.

I attest I will follow:

Confidentiality: I will consider as confidential all information which I may hear or see, directly or indirectly, concerning a patient, patient family member, doctor, or other health care professional and I will not seek information from any of the above in regard to a patient.

Infection Prevention: I understand and will adhere to COVID safe behaviors. I will wear appropriate Personal Protective Equipment (PPE) while volunteering, which will include a mask and eye protection, I will sanitize hands and work area as appropriate, and will social distance to the best of my ability.

I will not come to volunteer if I have any COVID symptoms, or other illness that may appear to be COVID.

Volunteer Agreement

As a volunteer, I understand and agree:

• To follow Confidentiality and COVID Safe Behaviors as listed above.
• I will complete the background check as requested.
• I hereby certify the answers on this application are true and correct and any misrepresentations or omissions of facts, misleading, or false information on my part will be grounds for dismissal as a volunteer. Acceptance as a volunteer is contingent upon verification of information submitted on the application and satisfactory completion of mandatory requirements. I authorize all employers, schools, or references thus contacted be released from all liability in answering questions related to my application.
• My services are donated to NASP without contemplation of compensation or future employment and given with humanitarian or charitable reasons.
• I authorize NASP to administer emergency medical treatment to me should I need it while volunteering.
• I understand NASP is not responsible for volunteers before or after their assigned volunteer shifts.
• Opportunities for volunteers are provided without regard to religion, creed, race, national origin, age, gender or
• sexual orientation.
• Completing an application does not guarantee volunteer placement since the number of applicants may exceed
• the number of available openings.
• NASP is not obligated to provide a volunteer placement, nor are you obligated to accept the position offered.
• All applications will be held for 6 months.
• By checking 'I agree' this serves as your agreement and approval of the statements in this volunteer agreement.