Group Application

Cottage Cove Group Volunteer Application (Only Use If Requested by Staff)
Which Campus will you be volunteering at?*

Madison (301 Woodruff St)Tusculum (4908 Aquatic Rd)Glencliff (149 Antioch Pike) - Coming
Today's Date*

MonthDayYear
This form is specifically for one-time volunteers or volunteers who are coming as part of service groups sent from a school (or other similar organization) in which their service will likely be short term or irregular. If you have not been directed to use this form, please fill out the long form volunteer application on http://www.cottagecove.org/volunteers.htm.

By providing your name, date of birth and social security number you acknowledge that Cottage Cove has the right to perform a background check using your personal information.
Full Name*

First NameLast Name
Date of birth*

MonthDayYear
Social Security Number*
No regular program volunteer shall be younger than 15. Exceptions must be made only by the Director of Operations or Executive Director and will only be made wherein there is specific extraordinary reason, such as advanced academic promotion (i.e. wherein the teen has had early promotion to a higher grade).
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
Phone Number (Cell Preferred)*

Area CodePhone Number
School or organization from which you are volunteering:
Name of volunteer service coordinator:
By signing this form I acknowledge that should a medical emergency arise and in the event that I am unable to authorize such treatment, I hereby authorized Cottage Cove staff to secure any medical treatment, or transportation, they deem necessary. I understand that I am responsible for any or all cost involved in such transportation or treatment.

In my choosing to participate in any activity at Cottage Cove, and particularly those with physical exertion or motion (including games and playground), I acknowlegde that I understand the risks (whether expressed or not) and that I have the physical stamina and dexterity to accept such involvement.
By signing this form, I agree to to abide by all rules established concerning proper conduct for volunteers (as posted online: www.cottagecove.org, or within the Cottage Cove facility), including usage of cell phones, appropriate footwear, jewelry, and reasonably modest apparel. Should my failure to follow these rules cause harm to myself or others, I hold Cottage Cove free from any liability. In volunteering at Cottage Cove, I consent to unremunerated use of my image in photographs, video, web or promotional materials. I also acknowledge that Cottage Cove will contact my references (including the volunteer service coordinator) and perform background checks on me as necessary.

I also signifiy that I have read and will abide by Cottage Cove's Employment Policy Concerning Age and Accoutability. This policy may be read and printed from: www.cottagecove.org/employmentpolicy.pdf. If I am a viewed a minor by state law, I also certify that my parent(s) and/or guardians are aware of my involvement, the provisions herein, and have given their assent to such participation with all these provisions.
Please sign by drawing (if possible) and by typing signature (whether or not drawn)
Signature

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Type full name*
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Cottage Cove Group Volunteer Application (Only Use If Requested by Staff)

Please sign by drawing (if possible) and by typing signature (whether or not drawn)