Welcome to the YMCA! YMCA Facts & Figures

Size: px
Start display at page:

Download "Welcome to the YMCA! YMCA Facts & Figures"

Transcription

1 t Welcome to the YMCA! Welcome to the YMCA of Martha's Vineyard! We are thrilled that you are volunteering with us! Attached are a few forms that we require Volunteers to complete and sign. Please return the completed forms to your supervisor or to Human Resources. YMCA Facts & Figures The Y is the nation's leading nonprofit organization for youth development, healthy living, and social responsibility. The Y is a powerful association of men, women, and children committed to bringing about lasting personal and social change. With a focus on nurturing the potential of every child and teen, improving the nation's health and well-being, and providing opportunities to give back and support neighbors, the Y enables youth, adults, families and communities to be healthy, confident, connected, and secure. In the U.S., the Y is comprised of YMCA of the USA, a national resource office, and more than 2,600 YMCAs with approximately 20,000 fulltime staff and 500,000 volunteers in 10,000 communities across the country. The Y engages 9 million youth and 12 million adults in 10,000 communities across the U.S. Worldwide, the Y serves more than 45 million people in 124 countries. Ys across the U.S. play an integral role in strengthening the leadership and youth programs of the Y around the world. Members, staff and volunteers of the Y include men, women and children of all ages and from all walks of life. The Y offers programs, services and initiatives focused on youth development, healthy living and social responsibility, according to the unique needs of the communities it engages. The Y is accessible to all people. Financial assistance is offered to individuals and families who cannot afford membership. The Y is guided by four core values: caring, honesty, respect, responsibility.

2 Mandatory Training for All Volunteers We require that all volunteers complete all of the following courses through Redwoods: Child Sexual Abuse Prevention course (1 hour) Sexual Harassment Prevention course (30 minutes) Slips, Trips and Falls course (30 minutes) Safe Lifting course (20 minutes) Appropriate Touch course (15 minutes) Social Media and Technology course (20 minutes) These are online courses and can be taken on any computer with internet access (at home, public library, etc.), and must be completed before the first day of work. Volunteers will not be scheduled until all courses are completed. A link to the training website is below. A link can also be found on our website ( on the "About Us" page in the "Employee Forms & Links" section. To take a course: 1. Visit 2. Click on "I Am A New User" 3. Select your state and association name 4. Enter your Access Code, which is: Fill out the registration information and create a user name and password 6. To find the courses, click on the "Home" tab at top of page, then click on "Adult Courses" 7. The courses are listed under "Core Courses" on the left side of the screen 8. Complete all of the above mentioned courses Please note: Mac users will need to use Firefox as their browser to access the courses.

3 VOLUNTEER CONTACT FORM Volunteer Information: Name: Department: Position: Mailing Address Physical Address (if different) Home Phone # Cell # Emergency Contact Information: (1) Name: Relationship: Address: Home Phone: Cell: Work Phone: (2) Name: Relationship: Address: Home Phone: Cell: Work Phone: I have voluntarily provided the above contact information and authorize YMCA of Martha's Vineyard and its representatives to contact any of the above on my behalf in the event of an emergency. I choose not to furnish any emergency contact information to YMCA of Martha's Vineyard at this time. I authorize YMCA of Martha ' s Vineyard to have an ambulance transport me to the Emergency Room at Martha's Vineyard Hospital if it is deemed to be necessary. In the event of an emergency, I authorize YMCA of Martha's Vineyard to inform emergency personnel of the medical/health condition(s) (including allergies, etc.) described below. This medical information will be maintained confidentially and will only be disclosed to medical personnel as necessary. Medical/Health Conditions: Volunteer s Signature: Date:

4 Please keep a copy of the Code of Conduct for your records. CODE OF CONDUCT Revised 5/14/2013 I have read the YMCA of Martha's Vineyard's Code of Conduct either in hardcopy form through Human Resources or in the Employment section of the YMCA of Martha's Vineyard website at the following link: I understand that it is my responsibility to acquaint myself with the contents of the Policy and I hereby agree to comply with the Policy. I understand and acknowledge that if I have any questions concerning this Policy, or do not understand its contents, I should contact the YMCA of Martha's Vineyard Human Resources office at (508) , ext This signed and completed form must be returned within 30 days of receiving this information to your Human Resources representative. Failure to do so will not affect the applicability of the code of conduct or any of its provisions to you. Employee Signature Print Name Date

5 YMCA of Martha s Vineyard Code of Conduct Revised 5/14/2013 Our Core Values: Caring Honesty Respect Responsibility As an employee of the YMCA of Martha s Vineyard, I will exemplify the Y s four core values while working within the YMCAMV, when using social media/cell phones as well as in our community. I am an ambassador of the YMCA of Martha s Vineyard and understand that my behavior outside the YMCAMV reflects upon the organization. Caring: show a sincere concern for others, for their needs and well-being. Honesty: be truthful in what I say and do. Respect: follow the golden rule. Treat others with fairness, courtesy and value what each individual has to contribute. Responsibility: do what is right, be accountable for my promises, actions and intentions. I will be vigilant and use what I learned in the YMCA of Martha s Vineyard s six required Redwoods online trainings: 1) Child Sexual Abuse Prevention 2) Sexual Harassment Prevention 3) Appropriate Touch 4) Social Media and Technology 5) Slips, Trips and Falls 6) Safe Lifting I understand that the key to protecting our members, visitors, and staff is awareness. I will report any incidents immediately to my supervisor, CEO or Human Resources. I will take pride in my work. I will come to work on time and be free of drugs or alcohol. I will tell my supervisor if I am on prescription drugs that may affect my work performance. I will have positive communication with our membership, visitors and other staff members equally regardless of sex, race, religion, ethnicity, culture, economic level, sexual orientation or disability.

6 VOLUNTEER HANDBOOK ACKNOWLEDGMENT I have received a copy of the YMCA of Martha's Vineyard's Volunteer Handbook ("Handbook"). I acknowledge my obligation to read and understand its contents. I understand that it is my responsibility to acquaint myself with the contents of the Handbook and that neither this Handbook nor any other communication except for a written contract from YMCA of Martha's Vineyard shall constitute a contract of employment for any specified duration. I hereby agree to abide by the rules, regulations, and policies of YMCA of Martha's Vineyard. This Handbook supersedes any previous employee manual that may have been issued by YMCA of Martha's Vineyard. I also understand that the guidelines may be changed at any time by the YMCA of Martha's Vineyard with or without prior notification to me and without agreement by me. I acknowledge that during the course of my volunteering with the YMCA of Martha's Vineyard, any photos taken of me maybe used in any promotional materials. I agree to comply with YMCA of Martha's Vineyard policies contained within this Handbook. I understand and acknowledge that if I have any questions concerning this Handbook, or do not understand its contents, I should contact YMCA of Martha's Vineyard Human Resources office at (508] x 125. Volunteer's Name (Print) Volunteer's Signature Date Name of Volunteer's Parent/Guardian if Volunteer is Under 18 (Print) Signature of Parent/Guardian if Volunteer is Under 18 Date All Volunteers must sign this Acknowledgement form and return it to Human Resources. Please keep the Handbook for your records.

7 YMCA of Martha ' s Vineyard, Inc. Volunteer Handbook Welcome to the YMCA of Martha's Vineyard. We are delighted that you are volunteering with us! We have designed this handbook to provide you and other volunteers with a general source of information about the YMCA of Martha's Vineyard. Your immediate supervisor at the YMCA can answer most questions you may have. Mission Our mission is to improve the quality of life for children, individuals, and families and the island community by helping all people realize their fullest potential through the development of mind, body, and spirit. YMCA Values Character development is integral to all YMCA programs. We are guided by our four core values of caring, honesty, respect, and responsibility. In childcare, the gym, at day camp, and at the Membership Desk we strive to develop character values in ourselves, our members, and participants. We believe strongly in our mission to promote and model these character-building values in all that we do. YMCA History The YMCA was founded in London, England in 1844 and came to the United States in YMCAs spread fast and were soon serving boys and men of all ages. After World War I, women and girls became an active part of the YMCA and today over half of YMCA members and staff are women. The YMCA is an international organization with YMCAs in over 130 different countries. Our YMCA The YMCA of Martha's Vineyard is a non-profit organization that provides year-round services for working and single-parent families, prevents and intervenes in youths' engagement in risky behaviors, brings different sectors of the Island's population together through a variety of services and programs that serve their needs, and develops health and prevention programs, leadership development, job skills training, learning opportunities and athletic and leisure activities. The YMCA has been successfully developing and running youth programs since its inception in 2003 as a Y Without-Walls, including an After School Program for K-6 students, a Summer Camp for K-8 students, a Fusion Program for middle school students, a Teen Center for grade 9-12 students, English Language Learners for children of immigrant families, and a variety of programs geared toward adults and seniors. In June 2010, the YMCA moved into our new $11 million handicapped-accessible facility - built with support from our committed Board and staff, the year-round community, and seasonal residents. Our vision is to create a year round recreational community center that brings Islanders and visitors of every age group and economic level together in one place to help them attain their individual goals in a balanced holistic method. In our first year of operations, the YMCA has been able to better achieve its goals by building new programs to meet the community needs, as well as expand current programs offered in previous years. The YMCA's membership base makes up over a quarter of the Island population, with a diverse representation of our Island community. Volunteering Volunteers are the backbone of the YMCA. Volunteers not only founded the YMCA, but also operated it in its entirety in the early days. The involvement today of thousands of talented, committed individuals greatly extends the range, quality and variety of YMCA programs. The YMCA defines a volunteer as anyone who, without financial compensation or expectation of compensation beyond reimbursement of out-of-pocket expenses, performs a task at the direction of and on behalf of the YMCA of Martha' Vineyard.

8 To avoid misunderstandings, volunteers may not work in an employed YMCA position in the same capacity (or a similar capacity) to their volunteer responsibilities. This applies to all YMCA programs and childcare extensions within the YMCA of Martha's Vineyard. We do want you to know that during your volunteer work with the YMCA of Martha's Vineyard, any photos taken of you may be used in future promotional materials. Background Checks and Volunteer Records All volunteers must undergo criminal background checks. If required by law, you may also need to present a report of a current physical examination prepared by a licensed physician. In order to keep your volunteer records current, you should notify your YMCA supervisor immediately of changes to your name, address, telephone number or emergency contact information. Benefits The YMCA does not provide insurance and related benefits to volunteers. As an example, there are no insurance plans for volunteers, including no medical, accident, dental, workers compensation, disability, or other coverage. The YMCA does not offer free memberships to volunteers. Volunteers may not trade their time for free or reduced cost program participation. Expenses Reasonable expenses incurred by volunteers on authorized YMCA business will be reimbursed following Internal Revenue Service guidelines and subject to prior approval of the volunteer's YMCA supervisor or the Executive Director. Airfare, hotels, and other similar expenses must be booked at the lowest possible rate. Receipts must be kept and properly submitted with the expense claim. Use of Supplies and Equipment YMCA supplies and equipment, including copy machines and postage meters, are for YMCA business only. Equipment and supplies purchased by or donated to the YMCA belong to the YMCA, and not to individuals. YMCA Property The YMCA may retrieve, inspect, and review both business and personal information and items stored in or on YMCA property, such as computers, diskettes, desks, lockers, cabinets, and YMCA vehicles. You are discouraged from bringing valuables to the YMCA, as the YMCA does not assume responsibility for loss, theft, or damage to volunteer's personal property. Use of Personal Vehicles Volunteers must not drive other volunteers, members, program participants, and staff on YMCA business without the expressed approval of the Executive Director. Safety and Health Rules Volunteers are to observe all safety and health rules and use care to prevent accidents. The following list is not inclusive: Observe all hazard warnings and no smoking signs; Use all safety equipment required for your assignment, including wearing appropriate personal protective equipment for eyes, face, head, hands, and other extremities; Know the location of fire/safety exits and evacuation procedures; Keep all aisles, walkways, work ways, working areas, and emergency equipment free of obstacles; Refrain from running, fighting, horseplay, or distracting others; Observe safe operating procedures for all equipment; make sure that all guards and other protective devices are in their proper places prior to operating the equipment; and operate only equipment for which you are authorized and properly trained; Do not wear frayed, torn or loose clothing, jewelry, or long unrestrained hair, near moving machinery or

9 electrical equipment; Follow proper lifting procedures at all times. Blood Borne Pathogens The YMCA subscribes to the concept of universal precautions which means that all human blood or other body fluids must be treated as if it were contagious. It means that you are expected to use certain procedures and to use personal protective equipment when necessary. Child Abuse Prevention A principal endeavor of the YMCA is to provide a healthy atmosphere for the growth and development of children. Thus, the mistreatment or neglect of children, and the resulting severe effects, is of primary concern to the YMCA. Child abuse is mistreatment or neglect of a child by parent(s) or others resulting in injury or harm. Abuse can lead to severe emotional, physical and behavioral problems. Because of our concern for the welfare of children, the YMCA has developed policies, procedures and training to aid in the detection and prevention of child abuse. Some of the guidelines you are expected to follow are: Never be alone with a single child where staff or other adults cannot observe you; You may not relate one on one to children who participate in YMCA programs outside of approved YMCA activities without the advance written approval of the Executive Director or your Progr am Director. For example, baby-sitting, weekend trips, foster care, etc. are not permitted; Dating a program participant under 18 is not allowed; Children may not be disciplined by use of physical punishment or by failing to provide the necessities of care; Verbally, physically, sexually, or emotionally abusing or punishing children is not allowed; Children must only be released to authorized persons; Any information regarding abuse or potential abuse should be documented in writing; At the first reasonable cause to believe that child abuse exists, it should be reported to your YMCA supervisor, Executive Director or Program Director; In the event that the YMCA has reason to believe that a volunteer abused a child, his or her conduct will be reported to the appropriate authorities, and the volunteer's YMCA involvement will be ended; Confidentiality of information related to child abuse is crucial and should be limited to the YMCA immediate supervisor, Executive Director, and/or Program Director. Misconduct Volunteers are expected to behave in a manner that is consistent with the YMCA mission, values, and goals. The YMCA does not tolerate misconduct. Some examples of misconduct include: Discriminatory behavior or harassment; Child abuse, molestation, or indecent exposure; Failure to report arrest or criminal conviction, if required to do so; Mistreatment or neglect of members, guests, or YMCA participants; Falsification of any YMCA records; Theft or willful damage to YMCA property or the property of others, or the removal of property without permission from YMCA management; Dishonesty in any form; Abusive or profane language; Fighting or threatening to harm another person; Possession of a weapon; Being under the influence of drugs or alcohol on YMCA premises or at a YMCA program; Possessing, distributing, or manufacturing controlled substances; Horseplay, unsafe, or dangerous behavior; Violation of any stated rules, or of commonly accepted rules of responsible personal conduct;

10 Conduct that does not support the stated purpose of the YMCA. This list is not all-inclusive. Harassment All individuals at the YMCA are expected to work actively to maintain an environment which is free from unlawful discrimination and harassment; and to conduct themselves in such a way as to ensure that no illegal discrimination or harassment occurs by employees, or other parties, including members, suppliers, and volunteers. Harassment includes unsolicited remarks, gestures or physical contact; display or circulation of written ma terials or pictures derogatory to either gender or to racial, ethnic or religious groups. Sexual harassment is a type of harassment and occurs when this type of verbal or physical conduct is sexual in nature or is gender based; that is, directed at a person because of their gender. If you feel you have been subjected to harassment of any kind, you are encouraged to immediately identify the offensive behavior to the harasser and request that it stop. If the behavior does not immediately stop, or if you prefer not to address the behavior directly with the harasser, you should immediately bring the situation to the attention of your YMCA supervisor, Program Director, Human Resources, or the Executive Director. Conflict of Interest Volunteers are expected to refrain from giving the impression that the personal views and positions they express regarding economic, political, or religious issues are those of the YMCA. Political Activity Due to Internal Revenue Service regulations for tax-exempt organizations such as the YMCA, the YMCA does not permit campaigning for a candidate of other political activities on YMCA premises, or using the resources of the YMCA for political activity. This prohibition includes, for example, wearing clothing or buttons with political slogans and displaying stickers and other political items at a YMCA facility or any YMCA program site. YMCA Information Information regarding membership lists, participant files, donors, YMCA staff and volunteers, financial aid, planning, medical conditions, and other information is confidential and must not be disclosed to anyone without the approval of a Branch Executive, Child Care Director, or the President/CEO. Arrest or Criminal Conviction of a Volunteer A volunteer is required to report an arrest or criminal conviction to the YMCA. The report should be made promptly, within five days of when the arrest or conviction occurred or prior to any additional volunteering, whichever comes first. The report should be made in writing to the YMCA Branch Executive or Child Care Director, and include the exact charge or conviction, the location of the courts, and the date of the arrest or conviction. Failure to report arrests or convictions as required may be considered misconduct. Volunteer Solicitation and Distribution The YMCA limits solicitations, surveys, petitions, and distributions on its premises. Unrestricted activities of this nature present a safety and security hazard, interfere with normal YMCA operations, and are intrusive and annoying to members and others. Except with the prior permission of the YMCA Executive Director, volunteers (and other individuals not employed by the YMCA) may not at any time solicit, survey, petition, or distribute literature on YMCA owned or operated sites. Alcohol and Drugs The YMCA is committed to maintaining an alcohol and drug free environment. That is particularly important since many volunteers are responsible for the safety and welfare of children and youth. Therefore, the YMCA prohibits the use, sale, manufacture or possession of alcohol or drugs (except those properly prescribed by a physician and used in accordance with the physician's instructions) by any volunteer while volunteering for the

11 YMCA, and/or while in any YMCA facility, vehicle or program site. Smoking The YMCA is committed to providing a smoke-free, safe and healthy environment. Smoking is not permitted in any of YMCA owned or operated facilities and program sites. Complaints If you have a complaint or problem at the YMCA, in most circumstances, the best course of action is to discuss the matter with your immediate supervisor at the YMCA. If your supervisor is unable to resolve the matter to your satisfaction, you should discuss your complaint or problem with the next level of YMCA supervision. Computer Software and Data Use Laws about the use of software are very strict. You may not copy YMCA software or bring a copy of software from home or another place of business and place the software on a YMCA computer. Voice Mail, , and Internet Use of data sent and stored on YMCA computers and communication systems is the property of the YMCA. These systems include telephone, facsimile, voice mail, electronic mail ( ) and Internet systems. Messages sent, stored, or printed on YMCA equipment are also the property of the YMCA. There can be no expectation of privacy when using these systems. These systems are for business use. Examples of inappropriate use of these systems include the use of ethnic slurs, racial epithets, sexually explicit images, jokes, cartoons, or anything that may be construed as harassment. It is also inappropriate to uses these systems for non-business information such as soliciting or proselytizing for commercial ventures, religious or political causes, or outside concerns. Media Relations Volunteers should refer all media inquiries to the Director of Marketing and Public Relations or the Executive Director, including nonemergency and emergency communication situations. Safety Related Certifications Safety training, including CPR and first aid, may be required for volunteers in certain positions. You are expected to take personal responsibility to ensure that your required certifications are always current. Orientation and Training Programs Many YMCA training events, such as program certification training, may be open to participation by volunteers, provided that it is related to the volunteer's YMCA responsibilities. You should direct your training requests to your YMCA supervisor. Questions? Consult your YMCA supervisor, or Executive Director, Jill Robie Axtell at ext. 102, or Human Resources Director, Ann Metcalf at ext Thanks for sharing your time and talent with the YMCA of Martha's Vineyard!

12 YMCA of Martha's Vineyard CONFIDENTIALITY AGREEMENT I, the undersigned, acknowledge the importance to the YMCA of Martha's Vineyard, Inc. ("YMCAMV") of protecting its confidential information and other legitimate interests. Therefore, in consideration of my volunteer status with YMCAMV and other good and valuable consideration, the receipt and sufficiency of which I hereby acknowledge: 1. I agree that, except as required for the proper performance of my regular duties for YMCAMV, I will never, directly or indirectly, use or disclose any Confidential Information as defined below. I understand and agree that this restriction will continue to apply after my volunteer status terminates, regardless of the reason for termination. 2. "Confidential Information" means any and all information of YMCAMV that is not generally available to the public and any and all information, publicly known in whole or in part or not, which, if disclosed by YMCAMV, would assist in competition against it, including but not limited to (i) YMCAMV products and services, technical data, methods and processes, (ii) YMCAMV's marketing activities and strategic plans, (iii) YMCAMV's costs and sources of supply, (iv) the identity and special needs of YMCAMV's constituents, prospective customers, and vendors and prospective vendors, (v) the people and organizations with whom YMCAMV has business relationships and those relationships. Confidential Information also includes any information that YMCAMV may receive or has received from those who do business with it with any understanding, express or implied, that the information would not be disclosed and any and all other information that YMCAMV treats in a confidential manner. 3. I agree that all Confidential Information which I create or to which I have access as a result of my volunteer status is and shall remain the sole and exclusive property of YMCAMV. Also, all documents, records and files, in any media of whatever kind and description, relating to the business, present or otherwise, of YMCAMV and any copies, in whole or in part, thereof (the "Documents"), whether or not prepared by me, shall be the sole and exclusive property of YMCAMV. I agree to safeguard all Documents and agree to return to YMCAMV immediately after my volunteer status terminates, and at such other times as maybe specified by YMCAMV, all Documents and all other property of YMCAMV then in my possession or control. 4. I represent and warrant to YMCAMV that my volunteer status by YMCAMV and my execution and performance of this Agreement will not breach or be in conflict with any other agreement to which I am a party or am bound or any other obligations I have to third parties and that I am not now subject to any covenants against competition or similar covenants that would affect my performance for YMCAMV. I agree that I will not disclose to YMCAMV any confidential and/or proprietary information of any former employer except with such former employer's consent. 5. This Agreement sets forth the entire agreement between me and YMCAMV and supersedes all prior communications, agreements and understandings, written or oral, with respect to the subject matter hereof. This Agreement may not be modified or amended, and no breach shall be deemed to be waived, unless agreed to in writing by me and an expressly authorized representative of YMCAMV. If any provision of this Agreement should, for any reason, be held invalid or unenforceable in any respect, it shall not affect any other provisions, and shall be construed by limiting it so as to be enforceable to the maximum extent permissible bylaw. 6. I acknowledge and agree that this Agreement does constitute a contract of volunteer status for a specific term and that either YMCAMV or I may terminate my volunteer status at any time, with or without notice or cause. Intending to be legally bound hereby, I have signed this Agreement as of the day and year written below. Signature: Printed Name: Date:

13 YMCA of Martha's Vineyard PROCEDURES FOR REPORTING SUSPECTED CHILD ABUSE The YMCA advocates a positive guidance and discipline policy with an emphasis on positive reinforcement, prevention, and the development of self-discipline. At no time will the following disciplinary techniques be tolerated: physical punishment, striking, biting, kicking, squeezing, shaming, withholding food or restroom privileges, confining children in small locked rooms, or verbal or emotional abuse. Affectionate touch and the warm feelings it brings is an important factor in helping a child grow into a loving and peaceful adult. However, YMCA staff and volunteers need to be sensitive to each person's need for personal space (i.e., not everyone wants to be hugged). The YMCA encourages appropriate touch; however, at the same time it prohibits inappropriate touch or other means of sexually exploiting children. In the event that there is an accusation or suspicion of child abuse, the YMCA will take prompt and immediate action as follows: 1. At the first report or probable cause to believe that child abuse has occurred, the individual will notify the Program Director, who will then review the incident with the YMCA Executive Director, or his/her designate. If the Program Director is not immediately available, the individual should report to the executive director or senior staff member. This review by the supervisor cannot in any way deter the reporting of child abuse by the mandated reporter. 2. The person receiving the initial report will be responsible for confirming the facts reported and the condition of the child on day of the first report. 3. Data concerning the child will be obtained through discussion with the initial reporter and other staff. 4. After the information is secured, the Executive Director or Program Director will call the Protective Services Unit of the Department of Social Services to report the case. Within 48 hours the Executive Director or Program Director will file a written 51A with the Department of Social Services, Protective Services Unit. If any of the individuals involved are enrolled in a child care program, the Department of Early Education and Care will be notified that a 51A was filed. If any of the individuals involved are enrolled in a day camp program, the Department of Public Health will be notified of the 51A filing. 5. On the same day that the case is first reported verbally to the Department of Social Services, it must be reported to the Director of Human Resources. 6. Any staff or volunteer named in a 51A report will, without exception, be suspended with pay until the Department of Social Services and/or the Office of Child Care Services or Department of Public Health have completed their investigations. A positive finding dictates immediate termination. 7. In the case of a disagreement (or uncertainty) concerning the need to report, the Executive Director or Program Director may not substitute his/her judgment for any mandated report. While agreement of all professionals involved is des irable, the Executive Director or Program Director must report to the Department of Social Services even if he/she believes the mandated reporter is incorrect. 8. The parents or legal guardian of the child(ren) involved in the alleged incident will be promptl y notified in accordance with the directions of the relevant state or local agency. 9. Whether the incident or alleged offense takes place on or off YMCA premises, it will be considered job related (because of the youth-involved nature of the YMCA). 10. Reinstatement of the program volunteer, or employed staff person will occur only after all allegations have been cleared to the satisfaction of the persons named in #1 above. 11. All YMCA staff and volunteers must be sensitive to the need for confidentiality in the handling of this information, and therefore, should only discuss the incident with the persons named in #1 above, All reports must be kept in a locked file. 12. All employees and program volunteers must read and sign this policy. Signature: Printed Name: Date: Important Numbers Massachusetts Department of Social Services HOTLINE: (800) Department of Social Services: (617) Hour Hotline: (800) 4A-CHILD

Please Print Affiliation (school, company name, etc): Mailing Address: City: Postal Code: Home Phone: Cell Phone: Work: Date of Birth (DD/MM/YY):

Please Print Affiliation (school, company name, etc): Mailing Address: City: Postal Code: Home Phone: Cell Phone: Work: Date of Birth (DD/MM/YY): Name: Volunteer Application Thank you for your interest in volunteering with Habitat for Humanity Wellington Dufferin Guelph. The information you provide will help us to place you in a volunteer position

More information

St. Jude Children s Research Hospital. Code of Conduct

St. Jude Children s Research Hospital. Code of Conduct 1 St. Jude Children s Research Hospital Code of Conduct 2 Dear Colleague: As a global leader in the research and treatment of pediatric catastrophic diseases, St. Jude Children s Research Hospital has

More information

Ashland Hospital Corporation d/b/a King s Daughters Medical Center Corporate Compliance Handbook

Ashland Hospital Corporation d/b/a King s Daughters Medical Center Corporate Compliance Handbook ( Medical Center ) conducts itself in accord with the highest levels of business ethics and in compliance with applicable laws. This goal can be achieved and maintained only through the integrity and high

More information

PATIENT BILL OF RIGHTS & NOTICE OF PRIVACY PRACTICES

PATIENT BILL OF RIGHTS & NOTICE OF PRIVACY PRACTICES Helping People Perform Their Best PRIVACY, RIGHTS AND RESPONSIBILITIES NOTICE PATIENT BILL OF RIGHTS & NOTICE OF PRIVACY PRACTICES Request Additional Information or to Report a Problem If you have questions

More information

Volunteer Policies & Procedures Manual

Volunteer Policies & Procedures Manual CASA of East Tennessee, Inc. Volunteer Policies & Procedures Manual Revised 2016 Funded Partner Agency This project is partially funded under an agreement with the State of Tennessee. Welcome The CASA

More information

Code of Conduct. at Stamford Hospital

Code of Conduct. at Stamford Hospital Code of Conduct at Stamford Hospital As a Planetree hospital, we are committed to personalizing, humanizing and demystifying the healthcare experience for patients and their families. Our approach is holistic

More information

The Code of Ethics applies to all registrants of the Personal Support Worker ( PSW ) Registry of Ontario ( Registry ).

The Code of Ethics applies to all registrants of the Personal Support Worker ( PSW ) Registry of Ontario ( Registry ). Code of Ethics What is a Code of Ethics? A Code of Ethics is a collection of principles that provide direction and guidance for responsible conduct, ethical, and professional behaviour. In simple terms,

More information

STANDARDS OF CONDUCT A MESSAGE FROM THE CHANCELLOR INTRODUCTION COMPLIANCE WITH THE LAW RESEARCH AND SCIENTIFIC INTEGRITY CONFLICTS OF INTEREST

STANDARDS OF CONDUCT A MESSAGE FROM THE CHANCELLOR INTRODUCTION COMPLIANCE WITH THE LAW RESEARCH AND SCIENTIFIC INTEGRITY CONFLICTS OF INTEREST STANDARDS OF CONDUCT A MESSAGE FROM THE CHANCELLOR Dear Faculty and Staff: At Vanderbilt University, patients, students, parents and society at-large have placed their faith and trust in the faculty and

More information

RESIDENT PHYSICIAN AGREEMENT THIS RESIDENT PHYSICIAN AGREEMENT (the Agreement ) is made by and between Wheaton Franciscan Inc., a Wisconsin nonprofit

RESIDENT PHYSICIAN AGREEMENT THIS RESIDENT PHYSICIAN AGREEMENT (the Agreement ) is made by and between Wheaton Franciscan Inc., a Wisconsin nonprofit RESIDENT PHYSICIAN AGREEMENT THIS RESIDENT PHYSICIAN AGREEMENT (the Agreement ) is made by and between Wheaton Franciscan Inc., a Wisconsin nonprofit corporation ( Hospital ) and ( Resident ). In consideration

More information

Frequently Asked Questions

Frequently Asked Questions 450 Simmons Way #700, Kaysville, UT 84037 (801) 547-9947 unar@davistech.edu www.utahcna.com Frequently Asked Questions UNAR stands for the Utah Nursing Assistant Registry, the agency in charge of the registry

More information

Facilities Department Accident Prevention Plan

Facilities Department Accident Prevention Plan Prepared By: Facilities Management team Revision Date: 2/12/18 1.0. PURPOSE The management of Edmonds Community College is committed to preventing accidents and ensuring the safety and health of our employees.

More information

1) INFORMATION ABOUT THE PARTICIPANT AND ACTIVITY

1) INFORMATION ABOUT THE PARTICIPANT AND ACTIVITY 2016-17 South Carolina 4-H Membership and Event Permission Form for Youth (Updated 08.01.16) ALL elements of this form must be completed by youth participating in clubs, field trips, events requiring group

More information

I. PURPOSE DEFINITIONS. Page 1 of 5

I. PURPOSE DEFINITIONS. Page 1 of 5 Policy Title: Computer, E-mail and Mobile Computing Device Use Accreditation Reference: Effective Date: October 15, 2014 Review Date: Supercedes: Policy Number: 4.31 Pages: 1.5.9 Attachments: October 15,

More information

L Ecole Culinaire Memphis

L Ecole Culinaire Memphis 2011 ANNUAL SECURITY REPORT Campus security and safety are important issues in postsecondary education today. In recognition of this fact, and in keeping with applicable federal requirements, L Ecole Culinaire

More information

Membership Application February 2013

Membership Application February 2013 Membership Application February 2013 DATE: PERSONAL INFORMATION Last Name: First Name: MI: of Birth: Social Security Number: CONTACT INFORMATION Street Name: Apt/Suite City State Zip Code Mailing Address

More information

Fox Chapel Area School District School Volunteer Manual

Fox Chapel Area School District School Volunteer Manual Fox Chapel Area School District School Volunteer Manual Manual includes school volunteer application and directions for completing the required clearances. Fox Chapel Area School District Volunteer Application

More information

KU MED Intranet: Corporate Policy and Procedures Page 1 of 6

KU MED Intranet: Corporate Policy and Procedures Page 1 of 6 KU MED Intranet: Corporate Policy and Procedures Page 1 of 6 Section: Policies Originating Volume: Medical Staff Title: Medical Staff Inappropriate Behavior Revised/Reviewed Date: 03/11/2003, 5/11/2004,

More information

Piedmont Healthcare, Inc. Code of Conduct

Piedmont Healthcare, Inc. Code of Conduct Piedmont Healthcare, Inc. Code of Conduct You are part of the Piedmont Healthcare family, a group of talented and dedicated people who take pride in what you do and are committed to our patients and our

More information

Chapter 247. Educators' Code of Ethics

Chapter 247. Educators' Code of Ethics 247.1. Purpose and Scope; Definitions. (a) (b) (c) (d) (e) Chapter 247. Educators' Code of Ethics In compliance with the Texas Education Code, 21.041(b)(8), the State Board for Educator Certification (SBEC)

More information

SCREENING GUIDE: NEW 4-H VOLUNTEERS

SCREENING GUIDE: NEW 4-H VOLUNTEERS SCREENING GUIDE: NEW 4-H VOLUNTEERS There are 3 steps to becoming a 4-H volunteer. See online or paper options for each step. Step A: Application ONLINE: https://sites.google.com/umn.edu/4-h-volunteer/apply

More information

Summer Camp Registration

Summer Camp Registration _ YMCA of the Sandhills Summer Camp Registration Fayetteville YMCA 2717 Fort Bragg Rd. Fayetteville, NC 28303 (910) 426-9622 op.4 North YMCA 3725 Ramsey Street Fayetteville, NC 28311 (910) 426-9622 op.

More information

Summer 2018 IP Summer Contract

Summer 2018 IP Summer Contract In consideration of my voluntary participation in the above International Program ( Program ), I, for myself, my heirs, personal representatives or assignees, agree as follows: 1. I agree to pay tuition

More information

2012/2013 ST. JOSEPH MERCY OAKLAND Pontiac, Michigan HOUSE OFFICER EMPLOYMENT AGREEMENT

2012/2013 ST. JOSEPH MERCY OAKLAND Pontiac, Michigan HOUSE OFFICER EMPLOYMENT AGREEMENT 2012/2013 ST. JOSEPH MERCY OAKLAND Pontiac, Michigan SAMPLE CONTRACT ONLY HOUSE OFFICER EMPLOYMENT AGREEMENT This Agreement made this 23 rd of January 2012 between St. Joseph Mercy Oakland a member of

More information

The Purpose of this Code of Conduct

The Purpose of this Code of Conduct The Purpose of this Code of Conduct This Code of Conduct provides a framework to guide us in meeting our obligations as employees and volunteers of HPC Healthcare, Inc., and its current and future affiliates,

More information

Welcome to LifeWorks NW.

Welcome to LifeWorks NW. Welcome to LifeWorks NW. Everyone needs help at times, and we are glad to be here to provide support for you. We would like your time with us to be the best possible. Asking for help with an addiction

More information

LIVING WORD CHRISTIAN SCHOOL CODE OF ETHICS

LIVING WORD CHRISTIAN SCHOOL CODE OF ETHICS Living Word Christian School accepts this code of ethics put forth by the Department of Education with the exception that nothing in these paragraphs shall be construed as limiting our freedom to teach

More information

Campus and Workplace Violence Prevention. Policy and Program

Campus and Workplace Violence Prevention. Policy and Program Campus and Workplace Violence Prevention Policy and Program SECTION I - Policy THE UNIVERSITY AT ALBANY is committed to providing a safe learning and work environment for the University s community. The

More information

General Policy. Code of Conduct

General Policy. Code of Conduct 1. Policy Statement 2. Purpose 3. Scope 4. Associated Policies and Procedures 5. Associated Documents General Policy Code of Conduct This Code of Conduct affirms that SAE Institute Pty Ltd ( the Institute,

More information

STANDARDS OF CONDUCT SCH

STANDARDS OF CONDUCT SCH STANDARDS OF CONDUCT SCH01242018 2018 LETTER FROM THE CEO Welcome, Thank you for choosing St. Croix Hospice. The care you provide impacts our patients, families, caregivers, and countless others every

More information

POLICY TITLE: Code of Ethics for Certificated Employees POLICY NO: 442 PAGE 1 of 8

POLICY TITLE: Code of Ethics for Certificated Employees POLICY NO: 442 PAGE 1 of 8 POLICY TITLE: Code of Ethics for Certificated Employees POLICY NO: 442 PAGE 1 of 8 It is the policy of this district that all certificated employees shall adhere to the Code of Ethics for Idaho Professional

More information

Attachment A: Code of Ethics for Volunteers with Vulnerable Populations

Attachment A: Code of Ethics for Volunteers with Vulnerable Populations Attachment A: Code of Ethics for Volunteers with Vulnerable Populations This Code of Ethics must be submitted along with the Application to Volunteer with Vulnerable Populations and Authorization for Release

More information

REFERENCES: (If applying to assist with religious activities, please include a member of the clergy as a reference.)

REFERENCES: (If applying to assist with religious activities, please include a member of the clergy as a reference.) BRRJA APPLICATION FOR VOLUNTEER SERVICES SITE: AA NA Academic Religious Other DATE: FULL NAME: Last First Middle HOME ADDRESS: Street City State Zip PHONE: Home Cell Work EMAIL ADDRESS: EDUCATION: HS Degree

More information

EMPLOYEE HANDBOOK EMPLOYEE HANDBOOK. Code of Conduct

EMPLOYEE HANDBOOK EMPLOYEE HANDBOOK. Code of Conduct EMPLOYEE HANDBOOK EMPLOYEE HANDBOOK L E A D I N G T E A C H I N G C A R I N G CODE OF CON DUCT Who We Are and What We Stand For In 2016, UNC Health Care adopted a system-wide. The purpose of this is to

More information

Telecommuting Policy - SAMPLE

Telecommuting Policy - SAMPLE Telecommuting Policy - SAMPLE XYZ Corporation considers telecommuting to be a viable alternative work arrangement in cases where individual, job and supervisor characteristics are best suited to such an

More information

PROVIDENCE HOSPITAL. Washington, D.C. SAMPLE RESIDENT CONTRACT FOR FAMILY MEDICINE

PROVIDENCE HOSPITAL. Washington, D.C. SAMPLE RESIDENT CONTRACT FOR FAMILY MEDICINE PROVIDENCE HOSPITAL Washington, D.C. SAMPLE RESIDENT CONTRACT FOR FAMILY MEDICINE AGREEMENT, made and entered into this day of,, between Providence Hospital (hereinafter referred to as the Hospital) and

More information

Sample Youth Protection Policy

Sample Youth Protection Policy Sample Youth Protection Policy Purpose understands the importance of protecting youth in the community and in our programs and therefore wishes to provide a safe and secure environment.

More information

Girl Scouts Dakota Horizons Volunteer Policies and Procedures

Girl Scouts Dakota Horizons Volunteer Policies and Procedures Girl Scouts Dakota Horizons Volunteer Policies and Procedures Table of Contents DISCLAIMER:... 2 INTRODUCTION... 3 TERMS... 3 NON-DISCRIMINATION AND DIVERSITY OF VOLUNTEERS... 4 ADULT MEMBERSHIP IN GSUSA...

More information

Student Participant Health Form

Student Participant Health Form Participant Name: Male Female Birth Age on arrival at program Month/Day/Year To Parent(s)/Guardian(s): Please follow the instructions below. Attach additional information if needed. 1. 2. Complete pages

More information

Code of Ethics and Professional Conduct for NAMA Professional Members

Code of Ethics and Professional Conduct for NAMA Professional Members Code of Ethics and Professional Conduct for NAMA Professional Members 1. Introduction All patients are entitled to receive high standards of practice and conduct from their Ayurvedic professionals. Essential

More information

CONTRACT OF AGREEMENT AND TERMS OF ADMISSION TO NEW LIFE USA RECOVERY CENTER

CONTRACT OF AGREEMENT AND TERMS OF ADMISSION TO NEW LIFE USA RECOVERY CENTER Free Drug and Alcohol Recovery Center Page 1 of 8 CONTRACT OF AGREEMENT AND TERMS OF ADMISSION TO NEW LIFE USA RECOVERY CENTER 1. THE PARTIES The following contract (AGREEMENT, hereafter) represents an

More information

EXAMPLE OF A PROFESSIONAL EXPECTATIONS FORM FOR RESIDENTS

EXAMPLE OF A PROFESSIONAL EXPECTATIONS FORM FOR RESIDENTS ext Button J BOUNDARY VIOLAIONS EXAMPLE OF A PROFESSIONAL EXPECAIONS FORM FOR RESIDENS (Modify for your own environment with input from your institution s human resources, risk management, or legal team)

More information

CODE OF CONDUCT POLICY

CODE OF CONDUCT POLICY CODE OF CONDUCT POLICY Mandatory Quality Area 4 PURPOSE This policy will provide guidelines to: establish a standard of behaviour for the Approved Provider (if an individual), Nominated Supervisor, Certified

More information

Code of Conduct Policy/Procedure Mandatory Quality Area 4

Code of Conduct Policy/Procedure Mandatory Quality Area 4 HDKA promotes a commitment to child safety, wellbeing, participation, empowerment, cultural safety and awareness including children with a disability, Aboriginal and Torres Strait Islander children and/or

More information

Volunteer Application

Volunteer Application Volunteer Application Submit to the Volunteer Recruitment Office at volunteer@patriotspoint.org Last Name: First Name: Address: City: State: Zip: Phone: Email: T-Shirt Size: Jacket Size: Occupation (or

More information

Junior Volunteer Program

Junior Volunteer Program 5126 Hospital Drive Covington, GA 30014 Tel: 770.788.6553 Andrea.Lane@piedmont.org Junior Volunteer Program Information Packet Piedmont Newton Hospital Volunteer Services Summer 2016 June 13 July 22 1

More information

HANDBOOK FOR VOLUNTEERS

HANDBOOK FOR VOLUNTEERS HANDBOOK FOR VOLUNTEERS Head Office - Unit 10/5-11 Hollywood Avenue Bondi Junction NSW 2022 www.hardiagedcare.com.au FACILITIES ARE LOCATED AT Blacktown Guildford Mountainview (Penrith) Seven Hills Wyoming

More information

UPMC HOSPITAL DIVISION POLICY AND PROCEDURE MANUAL. SUBJECT: Patients' Notice and Bill of Rights and Responsibilities DATE: July 27, 2012

UPMC HOSPITAL DIVISION POLICY AND PROCEDURE MANUAL. SUBJECT: Patients' Notice and Bill of Rights and Responsibilities DATE: July 27, 2012 UPMC HOSPITAL DIVISION POLICY AND PROCEDURE MANUAL POLICY: HS-HD-PR-01 * INDEX TITLE: Patient Rights/ Organizational Ethics SUBJECT: Patients' Notice and Bill of Rights and Responsibilities DATE: July

More information

Fox Chapel Area School District School Volunteer Manual

Fox Chapel Area School District School Volunteer Manual Fox Chapel Area School District School Volunteer Manual Manual includes school volunteer application and directions for completing the required clearances. Fox Chapel Area School District greatly appreciates

More information

MINOR Volunteer Application

MINOR Volunteer Application MINOR Volunteer Application (15 years and younger) Parent/Guardian/Legal Custodian Permission for Minor to participate in BPHI Volunteer Program and Consent for Emergency Medical treatment. Broward County

More information

THIS AGREEMENT made effective this day of, 20. BETWEEN: NOVA SCOTIA HEALTH AUTHORITY ("NSHA") AND X. (Hereinafter referred to as the Agency )

THIS AGREEMENT made effective this day of, 20. BETWEEN: NOVA SCOTIA HEALTH AUTHORITY (NSHA) AND X. (Hereinafter referred to as the Agency ) THIS AGREEMENT made effective this day of, 20. BETWEEN: NOVA SCOTIA HEALTH AUTHORITY ("NSHA") AND X (Hereinafter referred to as the Agency ) It is agreed by the parties that NSHA will participate in the

More information

Google Impact Challenge: SOUTH AFRICA OFFICIAL RULES

Google Impact Challenge: SOUTH AFRICA OFFICIAL RULES Google Impact Challenge: SOUTH AFRICA OFFICIAL RULES THIS CHALLENGE IS OPEN ONLY TO ORGANIZATIONS THAT MEET THE ELIGIBILITY CRITERIA DESCRIBED BELOW (" ORGANIZATION "). ENTRY IN THIS CHALLENGE CONSTITUTES

More information

Patient Rights and Responsibilities: Working Together to Ensure Remarkable Care EXPANDED VERSION

Patient Rights and Responsibilities: Working Together to Ensure Remarkable Care EXPANDED VERSION Patient Rights and Responsibilities: Working Together to Ensure Remarkable Care EXPANDED VERSION St. Joe s is committed to providing compassionate and respectful care. Your health care team will: Care

More information

Rehab Centers - Pediatric Specialty Therapy. Pediatric Outpatient Handbook

Rehab Centers - Pediatric Specialty Therapy. Pediatric Outpatient Handbook Rehab Centers - Pediatric Specialty Therapy Pediatric Outpatient Handbook Dear Patient/Parent, Thank you for choosing Hanover Hospital Rehab Centers Pediatric Specialty Therapy for your child s therapy/rehabilitation.

More information

Macon County Mental Health Court. Participant Handbook & Participation Agreement

Macon County Mental Health Court. Participant Handbook & Participation Agreement Macon County Mental Health Court Participant Handbook & Participation Agreement 1 Table of Contents Introduction...3 Program Description.3 Assessment and Enrollment Process....4 Confidentiality..4 Team

More information

POSITION STATEMENT. - desires to protect the public from students who are chemically impaired.

POSITION STATEMENT. - desires to protect the public from students who are chemically impaired. Page 1 of 18 POSITION STATEMENT The School of Pharmacy and Health Professions: - desires to protect the public from students who are chemically impaired. - recognizes that chemical impairment (including

More information

Values: Respect-Integrity-Communications-Responsiveness VOLUNTEER POLICY

Values: Respect-Integrity-Communications-Responsiveness VOLUNTEER POLICY The mission of St. PJ's Children's Home is to serve the needs of children and families by providing a safe, nurturing community to heal body, mind and spirit, shape successful adults, and break the cycle

More information

WELCOME. Payment will be expected at the time of service. Please remember our 24 hour cancellation notice.

WELCOME. Payment will be expected at the time of service. Please remember our 24 hour cancellation notice. WELCOME Those of us at Crossroads Counseling want to thank you for choosing to work with us and we want to make your time with us as productive as possible. In order to expedite the intake process, please

More information

SAISD Volunteer Information Packet

SAISD Volunteer Information Packet SAISD Volunteer Information Packet Thank you for choosing to volunteer in the San Antonio Independent School District. We hope that the time that you spend volunteering at SAISD is both fun and rewarding.

More information

Volunteer Application Packet

Volunteer Application Packet Volunteer Application Packet Thank you for your interest in the TechTutor Volunteer Program. This Application Packet contains the Application Checklist, and Request for Criminal History & Disclosure forms.

More information

CODE OF CONDUCT POLICY

CODE OF CONDUCT POLICY CODE OF CONDUCT POLICY PURPOSE This policy will provide guidelines to: establish a standard of behaviour for the Approved Provider (if an individual), Nominated Supervisor, Certified Supervisor, educators

More information

Our Codes of Conduct are underpinned by the following core values:

Our Codes of Conduct are underpinned by the following core values: APC CODES OF CONDUCT The APC has created the following set of Codes of Conduct to guide and protect the health, safety and well-being of its staff, volunteers, athletes and the individuals and organisations

More information

2017 Summer Camp Registration

2017 Summer Camp Registration 1515 N. Galloway Avenue Mesquite, Texas 75150 972.216.6260 www.cityofmesquite.com 2017 Summer Camp Registration Please select which camp your child(ren) will be attending BLAST Camp Sports Camp Teen Camp

More information

Bridgepoint Health. Guide to Interpretation and Application of Code of Ethics

Bridgepoint Health. Guide to Interpretation and Application of Code of Ethics Bridgepoint Health Guide to Interpretation and Application of Code of Ethics 1 Table of Contents Bridgepoint Health Code of Ethics... 3 I. Introduction... 5 II. Purpose... 5 III. Applicability... 5 IV.

More information

TrainingABC Patient Rights Made Simple Support Materials

TrainingABC Patient Rights Made Simple Support Materials TrainingABC 2017 Patient Rights Made Simple Support Materials Video Transcript The Patient Bill of Rights is a list of rights first developed in 1973 and then revised in 1992, by the American Hospital

More information

ICM Food & Clothing Bank Volunteer Application

ICM Food & Clothing Bank Volunteer Application Please print legibly. Date: / _/ ICM Food & Clothing Bank Volunteer Application Name: Email: Tel: ( ) Cell: ( ) Address: City: State: Zip: Emergency Contact Tel: 1. How did you hear about ICM? (i.e., school,

More information

Glastonbury YMCA 29 Welles Street, Glastonbury CT Dear YMCA Family,

Glastonbury YMCA 29 Welles Street, Glastonbury CT Dear YMCA Family, s Dear YMCA Family, Thank you for choosing the Glastonbury Family YMCA Preschool for your early childhood child care needs. We are excited to welcome you and your family to our program! The Y s focus is

More information

RELATIONS WITH LAW ENFORCEMENT AUTHORITIES AND SOCIAL SERVICE AGENCIES

RELATIONS WITH LAW ENFORCEMENT AUTHORITIES AND SOCIAL SERVICE AGENCIES Regulation KLG-RA Las Cruces Public Schools Related Entries: Responsible Office: JIH, JIH-R, KLG, KI, KI-R Associate Superintendent for Operations RELATIONS WITH LAW ENFORCEMENT AUTHORITIES AND SOCIAL

More information

Boy Scout Troop 692 Code of Conduct and Discipline Policy

Boy Scout Troop 692 Code of Conduct and Discipline Policy Boy Scout Troop 692 Code of Conduct and Discipline Policy The Troop expects all Scouts to behave in accordance with the Boy Scout Law. Scouting events happen in a friendly, safe and supportive environment

More information

complete the required information. Internet access is provided in our office, if needed.

complete the required information. Internet access is provided in our office, if needed. K State Research and Extension Dickinson County 712 S Buckeye Avenue Abilene, KS 67410 (785) 263 2001 dk@listserv.ksu.edu Dear Potential Dickinson County 4 H Volunteer, Thank you for your interest in volunteering

More information

Client Information Form

Client Information Form Client Information Form Please read and complete all information requested. Date: Name: Address: City, State and Zip: Social Security Number: Home Phone: Work Phone: Cell Phone: E-mail: If client is a

More information

Campus Crime & Security Report Harrisburg Campus

Campus Crime & Security Report Harrisburg Campus Campus Crime & Security Report Harrisburg Campus Harrisburg University of Science & Technology strives to offer a safe and secure campus. The Director of Compliance has the primary responsibility for supervising

More information

HIPAA PRIVACY TRAINING

HIPAA PRIVACY TRAINING HIPAA PRIVACY TRAINING HIPAA Privacy Training Objective Present a general overview of HIPAA and define important terms Understand the purpose of HIPAA and the Privacy Rule Understand the term Protected

More information

HIGH-SCHOOL STUDENT VOLUNTEER PROGRAM

HIGH-SCHOOL STUDENT VOLUNTEER PROGRAM HIGH-SCHOOL STUDENT VOLUNTEER PROGRAM 2017-2018 School Year Volunteer Application Becoming part of the NUMC volunteer team is a process and has many steps. Please review all the information carefully with

More information

Google Impact Challenge: US OFFICIAL RULES

Google Impact Challenge: US OFFICIAL RULES Google Impact Challenge: US OFFICIAL RULES THIS CHALLENGE IS OPEN ONLY TO ORGANIZATIONS THAT MEET THE ELIGIBILITY CRITERIA DESCRIBED BELOW (" ORGANIZATION "). ENTRY IN THIS CHALLENGE CONSTITUTES YOUR ACCEPTANCE

More information

TELECOMMUTING AGREEMENT

TELECOMMUTING AGREEMENT TELECOMMUTING AGREEMENT This Telecommuting Agreement exists in accordance with the UAB/UAB Medicine Telecommuting Guidelines. This Telecommuting Agreement specifies the conditions applicable to an arrangement

More information

GATEWAY BEHAVIORAL HEALTH SERVICES VOLUNTEER/INTERNSHIP APPLICATION

GATEWAY BEHAVIORAL HEALTH SERVICES VOLUNTEER/INTERNSHIP APPLICATION PERSONAL INFORMATION GATEWAY BEHAVIORAL HEALTH SERVICES VOLUNTEER/INTERNSHIP APPLICATION NAME SOCIAL SECURITY # ADDRESS CITY/STATE/ZIP TELEPHONE EMERGENCY CONTACT RELATIONSHIP TO INTERN/VOLUNTEER TELEPHONE

More information

OMeGA Medical Grants Association RESIDENCY/CORE COMPETENCY INNOVATION GRANT RECIPIENT AGREEMENT. Order number* Program applicant name*

OMeGA Medical Grants Association RESIDENCY/CORE COMPETENCY INNOVATION GRANT RECIPIENT AGREEMENT. Order number* Program applicant name* OMeGA Medical Grants Association 2015-2016 RESIDENCY/CORE COMPETENCY INNOVATION GRANT RECIPIENT AGREEMENT Order number* Program applicant name* This Grant Recipient Agreement is between OMeGA Medical Grants

More information

BOC Standards of Professional Practice. Version Published October 2017 Implemented January 2018

BOC Standards of Professional Practice. Version Published October 2017 Implemented January 2018 BOC s of Professional Practice Implemented January 2018 Introduction The BOC s of Professional Practice is reviewed by the Board of Certification, Inc. (BOC) s Committee and recommendations are provided

More information

YMCA OF MIDDLE TENNESSEE AUTHORIZATION AND RELEASE FOR THE PROCUREMENT OF A CONSUMER AND/OR INVESTIGATIVE CONSUMER REPORT

YMCA OF MIDDLE TENNESSEE AUTHORIZATION AND RELEASE FOR THE PROCUREMENT OF A CONSUMER AND/OR INVESTIGATIVE CONSUMER REPORT YMCA OF MIDDLE TENNESSEE AUTHORIZATION AND RELEASE FOR THE PROCUREMENT OF A CONSUMER AND/OR INVESTIGATIVE CONSUMER REPORT *This information will be used for verification and identification purposes only

More information

The Family Crisis Center of East Texas, Inc. (Women s Shelter of East Texas)

The Family Crisis Center of East Texas, Inc. (Women s Shelter of East Texas) The Family Crisis Center of East Texas, Inc. (Women s Shelter of East Texas) Volunteer/ Advocate Application (Including Interns and Work Study) Please check one: (See Volunteer Categories for details)

More information

Behavioral Solutions. VolunteerHandbook. Guidelines for TrueCore Volunteers and Interns

Behavioral Solutions. VolunteerHandbook. Guidelines for TrueCore Volunteers and Interns Behavioral Solutions VolunteerHandbook Guidelines for TrueCore Volunteers and Interns 1 TrueCore Behavioral Solutions VolunteerHandbook TrueCore Behavioral Solutions is committed to building partnerships

More information

Susan Busler & Judi Peters Polk County 4-H Youth Development

Susan Busler & Judi Peters Polk County 4-H Youth Development E XTENSION SERVICE P OLK COUNTY March 24, 2017 To: Prospective 4-H Volunteers Re: New Volunteer Orientation Welcome to the wonderful world of 4-H! We re so pleased that you are joining - or are thinking

More information

GUIDE FOR INTERVENERS AND USERS

GUIDE FOR INTERVENERS AND USERS GUIDE FOR INTERVENERS AND USERS OF THE PATHWAYS TO MIYUPIMAATISIIUN SERVICES HEREBY REFERRED TO AS CODE OF ETHICS Approved by the Board of Directors on March 19, 2009 1 Table of Contents Introduction &

More information

POLK COUNTY SHERIFF S OFFICE DES MOINES AREA COMMUNITY COLLEGE APPLICATION FOR CRIMINAL JUSTICE CLUB

POLK COUNTY SHERIFF S OFFICE DES MOINES AREA COMMUNITY COLLEGE APPLICATION FOR CRIMINAL JUSTICE CLUB POLK COUNTY SHERIFF S OFFICE DES MOINES AREA COMMUNITY COLLEGE APPLICATION FOR CRIMINAL JUSTICE CLUB DATE / / NOTICE: APPLICATIONS MUST BE TYPEWRITTEN OR CLEARLY PRINTED IN BLACK INK. ALL QUIESTIONS MUST

More information

Risk Management Policy Template

Risk Management Policy Template Safety Education Risk Management Policy Template Introduction As a student organization at the University of Texas at Austin, we recognize the need to adopt a risk management policy. We acknowledge that

More information

Handout 8.4 The Principles for the Protection of Persons with Mental Illness and the Improvement of Mental Health Care, 1991

Handout 8.4 The Principles for the Protection of Persons with Mental Illness and the Improvement of Mental Health Care, 1991 The Principles for the Protection of Persons with Mental Illness and the Improvement of Mental Health Care, 1991 Application The present Principles shall be applied without discrimination of any kind such

More information

APPLICATION FOR EMPLOYMENT

APPLICATION FOR EMPLOYMENT APPLICATION FOR EMPLOYMENT 895 Mary Dunn Road, Hyannis, MA 02601 (508) 778.5040 Fax: (508) 778.9642 www.capeabilities.org Accredited by The Commission on Accreditation of Rehabilitation Facilities Thank

More information

Win a Panda Trek in Nepal Contest Official Rules

Win a Panda Trek in Nepal Contest Official Rules Win a Panda Trek in Nepal Contest Official Rules Introduction: The objective of this Contest is to promote the conservation of wildlife and wild places and to give the Mozilla community an opportunity

More information

ELLICOTT CITY VOLUNTEER FIREMEN S ASSOCIATION, INC.

ELLICOTT CITY VOLUNTEER FIREMEN S ASSOCIATION, INC. ELLICOTT CITY VOLUNTEER FIREMEN S ASSOCIATION, INC. APPLICATION FOR PROBATIONARY MEMBERSHIP Emergency ID# (assigned by LOSAP committee) (enter your 4 digit number if assigned one previously by Howard County)

More information

THE MONTEFIORE ACO CODE OF CONDUCT

THE MONTEFIORE ACO CODE OF CONDUCT THE MONTEFIORE ACO CODE OF CONDUCT 2017 Approved by the Board of Directors on March 10, 2017 Our Commitment to Compliance As a central part of its Compliance Program, the Bronx Accountable Healthcare Network

More information

FIRST AMENDED Operating Agreement. North Carolina State University and XYZ Foundation, Inc. RECITALS

FIRST AMENDED Operating Agreement. North Carolina State University and XYZ Foundation, Inc. RECITALS FIRST AMENDED Operating Agreement North Carolina State University and XYZ Foundation, Inc. This Operating Agreement (Agreement) is made between North Carolina State University (NC State) and XYZ Foundation,

More information

AGREEMENT BETWEEN: LA CLÍNICA DE LA RAZA, INC. AND MOUNT DIABLO UNIFIED SCHOOL DISTRICT

AGREEMENT BETWEEN: LA CLÍNICA DE LA RAZA, INC. AND MOUNT DIABLO UNIFIED SCHOOL DISTRICT AGREEMENT BETWEEN: LA CLÍNICA DE LA RAZA, INC. AND MOUNT DIABLO UNIFIED SCHOOL DISTRICT This agreement is made as of the day of, 2009 by and between the Mt. Diablo Unified School District, hereafter known

More information

STATE OF RHODE ISLAND DEPARTMENT OF CHILDREN, YOUTH AND FAMILIES PUBLIC NOTICE OF PROPOSED RULE-MAKING

STATE OF RHODE ISLAND DEPARTMENT OF CHILDREN, YOUTH AND FAMILIES PUBLIC NOTICE OF PROPOSED RULE-MAKING STATE OF RHODE ISLAND DEPARTMENT OF CHILDREN, YOUTH AND FAMILIES PUBLIC NOTICE OF PROPOSED RULE-MAKING In accordance with Rhode Island General Law (RIGL) 42-35 and 42-72-5, notice is hereby given that

More information

VOLUNTEER APPLICATION

VOLUNTEER APPLICATION Thank you for your interest in Estes Park Medical Center. The mission of the Estes Park Medical Center is to make a positive difference in the health and wellbeing of all we serve. VOLUNTEER APPLICATION

More information

Staff member: an individual in an employment relationship with CYM or a contractor who is paid for services.

Staff member: an individual in an employment relationship with CYM or a contractor who is paid for services. 13. 1 POLICY TO ADDRESS WORKPLACE HARASSMENT AND DISCRIMINATION 13.1 Policy Statement This policy is applicable to all persons in the CYM organization; those employed by the organization, those contracted

More information

THE ASCENSION HEALTH CORPORATE RESPONSIBILITY PROGRAM A MISSION BASED ON VALUES AND ETHICS

THE ASCENSION HEALTH CORPORATE RESPONSIBILITY PROGRAM A MISSION BASED ON VALUES AND ETHICS THE ASCENSION HEALTH CORPORATE RESPONSIBILITY PROGRAM A MISSION BASED ON VALUES AND ETHICS Ascension Health, its local health ministries, associates and agents are committed to carrying out their health

More information

Rhode Island College Club Sports Emergency Information Form

Rhode Island College Club Sports Emergency Information Form Rhode Island College Club Sports Emergency Information Form Contact Information Name: Email: Phone Number: Club Sport: Student ID #: Year in School: Local Address: (Street) (City) (State) (Zip) Person

More information

INLAND EMPIRE HEALTH PLAN CODE OF BUSINESS CONDUCT AND ETHICS. Our shared commitment to honesty, integrity, transparency and accountability

INLAND EMPIRE HEALTH PLAN CODE OF BUSINESS CONDUCT AND ETHICS. Our shared commitment to honesty, integrity, transparency and accountability INLAND EMPIRE HEALTH PLAN CODE OF BUSINESS CONDUCT AND ETHICS Our shared commitment to honesty, integrity, transparency and accountability UPDATED: February 2014 TABLE OF CONTENTS Topic Page A. The IEHP

More information

Sequel Youth and Family Services POLICY AND PROCEDURE. Domain: Administration and Leadership

Sequel Youth and Family Services POLICY AND PROCEDURE. Domain: Administration and Leadership Sequel Youth and Family Services POLICY AND PROCEDURE Subject: PREA Domain: Administration and Leadership Objective: To establish a process where Sequel Youth and Family Services employees have zero tolerance

More information

Effective Date: 08/19/2004 TITLE: MEDICAL STAFF CODE OF CONDUCT - POLICY ON DISRUPTIVE PHYSICIAN

Effective Date: 08/19/2004 TITLE: MEDICAL STAFF CODE OF CONDUCT - POLICY ON DISRUPTIVE PHYSICIAN MEDICAL STAFF POLICY & PROCEDURE Page 1 of 5 Effective Date: 08/19/2004 Review/Revised: 09/02/2011 Policy No. MSP 014 TITLE: MEDICAL STAFF CODE OF CONDUCT - POLICY ON DISRUPTIVE PHYSICIAN REFERENCE: MCP

More information