VolunTEENs ~ Community Services Department The Anaheim Community Services Department summer VolunTEEN program is for teens 13 17 years old who want to make a difference in their community! Teens will have the opportunity to be assigned at various locations throughout Anaheim: Oak Canyon Nature Center, East Anaheim Gymnasium, East Anaheim Community Center, Downtown Youth Center, West Anaheim Youth Center, Pearson Park Amphitheater, Tiny Tot Programs, and Senior Citizens Programs. QUALIFICATIONS Applicants must be a minimum of 13 years of age and have completed 5 th grade. Anaheim residents and students of high schools located in Anaheim will be given priority. Please note: We are no longer accepting 12 year old applicants at O.A.K.S. Day Camp. STEPS TO BECOMING A VOLUNTEEN 1. Return completed VolunTEEN application to Anaheim City Hall Community Services Dept. or during your orientation. 2. New and Returning VolunTEENs must attend an orientation with a parent or guardian. Please see schedule below. 3. First time applicants must have their fingerprints taken for a background check; see schedule below. 4. Teens will be notified of acceptance and placement via mail by the end of May. 5. Attend your program training as scheduled by your VolunTEEN supervisor. 6. Have fun, gain experience, and meet new friends! Orientation Locations Date Time Oak Canyon Nature Center 6700 E. Walnut Canyon Rd., Anaheim, CA 92807 Wednesday, April 15, 2015 6-7pm Oak Canyon Nature Center 6700 E. Walnut Canyon Rd., Anaheim, CA 92807 Friday, April 17, 2015 6-7pm East Anaheim Community Center 8201 East Santa Ana Canyon Road, Anaheim, CA 92808 Saturday, April 18, 2015 3-4pm Anaheim Downtown Community Center 250 E Center St, Anaheim, CA 92805 Monday, April 27, 2015 6-7pm Fingerprinting Locations Date Time Oak Canyon Nature Center April 15, 2015 7-8:30pm Appointment April 17, 2015 7-8:30pm Only East Anaheim Community Center April 11, 2015 10am-4pm Appointment April 18, 2015 10am-2:30pm or Walk-In Anaheim Downtown Community Center April 27, 2015 7-8pm Anaheim City Hall 200 S. Anaheim Blvd, Ste. 433, Anaheim, CA 92805 April-May 2015 10:30am- 4:30pm Appointment Only Appointment Only
CURRENT TB TEST AND FINGERPRINTING Please bring a copy of a TB test clearance slip or immunization card dated within the last two years (2013-present will be accepted). We are required to have a copy of our volunteers TB Tests in our records. Applicants are responsible for the cost of the test. Please note that State Law AB 1663 requires that all recreation program volunteers be fingerprinted for a background check and cleared by the Department of Justice before placement. Fingerprinting is available at no cost and must be completed by the program specialist. RECOGNITION & COMMUNITY SERVICE CONFIRMATION All teens who volunteer for a minimum of 5 hours will be invited to a VolunTEEN Thank You Celebration, at the end of the summer, where we will recognize those who have dedicated their time. School community service forms will also be completed if provided. APPLICATION RECEIPT AND DEADLINE Completed applications will be accepted beginning Wednesday, April 1 st, 2015. Applications will not be accepted prior to this date! Deadline to apply is Saturday May 2, 2015 - Applications must be received by 5pm on this day at Anaheim City Hall to be considered. Any application received or post marked after this day will not be accepted. Legibly print the entire VolunTEEN application and return in person or by mail to: City of Anaheim - VolunTEEN 200 S. Anaheim Blvd., Ste 433 Anaheim, CA. 92805 For questions or additional information, please call the VolunTEEN Program Specialist at (714) 765-4994 fax (714) 765-5223 OR email: volunteeroffice@anaheim.net
Volunteer Application SUMMER 2015 Please Check One: NEW RETURNING NAME: DATE OF BIRTH: AGE: (Please Print) Month/ Day/ Year MAILING ADDRESS: CITY: ZIP CODE: HOME TELEPHONE: CELL: TEEN E-MAIL ADDRESS: SCHOOL: PARENT/GUARDIAN: PARENT E-MAIL: (Please Print) (Please Print) CELL: WORK: (parent/guardian) (parent/guardian) Why are you volunteering (i.e.: experience, community involvement, general interest, school requirement, court order)? REQUIRED FOR ALL PROGRAM PARTICIPANTS I understand there is a time commitment involved and I am responsible for transportation to and from my assigned site. I also understand that placement is not guaranteed upon applying and if I do not follow program guidelines I may be released from my volunteer assignment. Participant: Date: (Signature) Parent/Guardian: Date: (Signature) City of Anaheim Attn: Volunteer Office 200 S. Anaheim Blvd Suite # 433 Anaheim, CA 92805 714.765.4994 / volunteeroffice@anaheim.net
NAME: Select and rank in order your top three locations for volunteering (Please rank 1-3) If you are interested in volunteering in more than one of your selected programs, please mark this box: O.A.K.S. Day Camp (Oak Canyon Nature Center: 6700 E. Walnut Canyon Rd., Anaheim, CA 92807(M-F 8am-1:30pm) East Anaheim Gymnasium (8165 East Santa Ana Canyon Rd., Anaheim, CA 92808) Pearson Park Amphitheatre (401 N. Lemon St., Anaheim, CA 92805) Friday Nights: 5-10pm Senior Citizens (Downtown Community Center; 250 E. Center St., Anaheim, CA 92805) Downtown Anaheim Youth Center (225 S. Philadelphia St., Anaheim, CA 92805) West Anaheim Youth Center (320 S. Beach Blvd., Anaheim, CA 92804) Special Events City Wide Clerical/ Front Office No Preference Project S.A.Y. Tiny Tots Academy (Program hours 9:00a.m. 12:00p.m.) Brookhurst Community Center; 2271 W. Crescent St., Anaheim, CA 92804 Peralta Recreation Center; 111 N. Pinney Dr., Anaheim, CA 92807 Oak Canyon Nature Center; 6700 E. Walnut Canyon Rd., Anaheim, CA 92807 East Anaheim Community Center; 8201 E. Santa Ana Cyn Rd., Anaheim, CA 92808 Fun On Wheels (2:45-5pm, order your top three locations in the boxes below) Mon Rio Vista Park (92806) Ross Park (92802) Tues Balsam Ave/ Curtis Ct. (92806) Benmore Ln/ Canfield Ln (92805) Wed Alameda/Brownwood/Catalina Ave (92801) Danbrook Elementary School (92804) Thur Glen Ave/Neighbors Ave (92801) Park Lane (92806) Fri Paul Revere Elementary School (92801) Kodiak Street (92807) For Office Use Only: Assigned to: By: (Volunteer Location) Assigned to: By: (Volunteer Location) Hold Harmless: By: Supplemental Questionnaire: By: Fingerprint Clearance Date: TB Clearance Date: SID# By: By:
2015 Summer VolunTEEN Program Opportunities OAK CANYON NATURE CENTER Oak Canyon Nature Center s O.A.K.S. Day Camp: Assist staff in providing a day camp program for ages 5-12. Activities take place entirely outdoors and include hikes, crafts, games, science, and outdoor activities. Volunteers must be at least 13 years of age and able to commit to the week in its entirety. Volunteers may request to work one or multiple weeks. Shifts run Monday-Friday 8:00 am-1:30 pm. TINY TOTS You will be working with preschool children 3-5 yrs. Teachers and students will need help with crafts, story time, and outdoor play. We prefer that our volunteers commit to at least one week at their location. Schedules vary with Monday-Friday, Mon/Wed/Fri, or Tues/Thurs from 8:30 am-noon at four different locations: Brookhurst Community Center, Peralta Recreation Center, Oak Canyon Nature Center, and East Anaheim Community Center. PEARSON PARK AMPHITHEATRE Summer Family Shows and Movie Nights: Volunteers will help with collecting tickets, oversee craft projects, ushering duties, and snack bar assistance as well as set up and take down of events. Summer Family Shows: Friday evenings, 5:00 pm-9:00 pm and some Saturday evenings for concerts June 19, 2015 July 10, 2015 August 7, 2015 June 26, 2015 July 17, 2015 August, 15, 2015 July 24, 2015 July 31, 2015 Movie Nights: Friday Evenings, 7pm-10pm. August 14, 2015 August, 21, 2015 SENIOR CITIZENS: Mature volunteers will interact, socialize, and participate in activities with the seniors at the Downtown Anaheim Community Center as well as help the program director prepare for future programs. Volunteers must commit to helping on Tuesdays and Thursdays from 9 am to 3 pm for 5 weeks. Applicants can choose from the first session: June 16 th -July 17th or the second session: July 21st August 18th. East Anaheim Gymnasium & Community Center Service hours depend on what you will be assigned to do. Possible activities include: coaching and assisting coaches in camps, clinics, and leagues throughout the year and special projects at the East Anaheim Community Center and Gymnasium. Schedules will be determined during the first meeting with the program director. Fun on Wheels: The mobile recreation program visits different locations every day to provide homework help, fitness fun, art enrichment, and resource materials to children after school. Volunteers would primarily be there to help the younger students with their homework. Volunteers for this program are responsible for their own transportation to the locations Monday- Friday, 2:45 pm-5 pm. General Community Services Department Assistance Volunteers may be assigned to assist with office work for different department sections at City Hall. Hours will vary depending on assignment.
CITY OF ANAHEIM MODEL CONSENT AGREEMENT & RELEASE OF LIABILITY (Minor Volunteer Form) In consideration of the engagement as a model of the minor named below, and for other good and valuable consideration herein acknowledged as received, I hereby grant to (photographer), City of Anaheim, their officials employees, volunteers, heirs, legal representatives, and assigns, those of whom Photographer is acting, and those acting with their authority and permission, the irrevocable and unrestricted right and permission to take, copyright, use, re-use, publish, and republish photographic portraits, pictures of me, or audio or video recording or in which I may be included, in whole or in part, or composite or distorted in character or form, without restriction as to changes or alterations, in conjunction with the minor s or a fictitious name, or reproductions thereof in color or otherwise, made through any medium and in any and all media now or hereafter known for illustration, promotion, art, editorial, advertising, trade, or any other purpose whatsoever. I also consent to the use of any published matter in conjunction therewith. I hereby waive any right that I or the minor may have to inspect or approve the finished product or products and the advertising copy or other matter that may be used in connection therewith or the use to which it may be applied. In exchange for the benefits derived by my participation in this project, I hereby agree that I, my heirs, distributees, guardians, legal representatives, and assigns do release and will indemnify, hold harmless and not sue the photographer, City of Anaheim, their officials, employees, representatives, agents, servants, or volunteers for any liability, claims, or actions for injury, death, or damage to personal property, claims for libel or violation of any right of publicity or privacy arising out of or in connection with my participation in the photography project, from whatever cause, including the active or passive negligence of the photographer, City of Anaheim, or their officials, employees, agents, representatives, volunteers, or project participants. I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND SIGNED IT OF MY OWN FREE WILL. Minor s Name Parent Signature Date Print Name Accepted by: City of Anaheim RM (3/ 09) Minor Photo Release
CITY OF ANAHEIM PUBLIC RESOURCES CODE SECTION 5164 SUPPLEMENTAL QUESTIONNAIRE For applicants under 18 years of age, the signature of parents or guardians must be obtained on this form as well as on the attached Consent/Release form relating to fingerprinting. The California Legislature, through Public Resources Code Section 5164, has enacted a law requiring prospective employees or volunteers who wish to perform services at a city park, playground, recreational center or beach used for recreation purposes, in a position having supervisory or disciplinary authority over any minor to complete an application that inquires as to whether or not that prospective employee or volunteer has been convicted of any offense in Section 11105.3 of the Penal Code. For purposes of this supplemental questionnaire, the term "conviction" includes adjudication under the Welfare and Institutions Code. Please circle "Yes" or "No" to the questions below. If you answer "Yes" to any of the following questions, please provide in the spaces below, the date and location (including the state and/or country) of each such conviction, the specific Penal Code section involved, whether in California or out of State, whether the conviction was deemed a misdemeanor or felony, the specifics of the crime and the disposition. Please also be advised that employment in this position is contingent upon a criminal records check. This records check will require the person to provide his/her fingerprints. Please be advised that failure to give complete and accurate information may be grounds for rejection of this application; removal of your name from the eligibility list or dismissal from your position if hired. 1. Have you ever been convicted of a violation or attempted violation of Sexual Battery? YES NO 2. Have you ever been convicted of a sex offense against a minor? YES NO 3. Have you ever been convicted of any crime that would require you to register as a sex offender in California or anywhere else, including any federal or military court? YES NO 4. Have you been convicted or incarcerated within the last ten (10) years for abusing or attempting to abuse a child; and/or endangering or attempting to endanger the health of a child? YES NO 5. Have you been convicted or incarcerated within the last ten (10) years for willfully inflicting upon a child any cruel or inhuman corporal punishment or an injury resulting in a traumatic condition? YES NO 6. Have you been convicted or incarcerated within the last ten (10) years for: Theft YES NO Robbery YES NO Burglary YES NO 7. Have you been convicted or incarcerated within the last ten (10) years for any felony? YES NO If you have answered, "YES" to any of the above questions, please provide the date, location, state and country of each conviction as well as the specific Penal Code Section involved, the specifics as to the crime involved and the disposition. CERTIFICATION OF APPLICANT I hereby certify that all responses herein are true and correct, and I understand and agree that any misstatement or omission of material fact may cause forfeiture on my part of all rights to employment by this City. Signature of Applicant Date Name of Applicant (Printed) (Or Parent/Guardian of Applicant under 18 years of age) Rev. 3/16/2012 /P:\Rec\SUPPORT SVCS & CUL ART.2\PERSONNEL\FORMS\Supplemental Questionnaire - March 2012.doc
Parental Consent- Release (FOR APPLICANTS UNDER THE AGE OF 18 ONLY) I, am the Parent/Guardian of, who is a (Parent/Guardian Name) (Minor s Name) minor and has applied for employment with or wishes to volunteer his/her services to the City of Anaheim Community Service Department. I understand and acknowledge that the City of Anaheim is required to comply with Public Resources Code Section 5164 which states that the City shall not hire a person for employment, or hire a volunteer to perform services in a city park, playground, recreational center, or beach used for recreational purposes in a position having supervisory of disciplinary authority over any minor if that person has been convicted of any offense specified in paragraph (1) of subdivision (h) of Section 11105.3 of the Penal Code or any offense specified in paragraph (3) of subdivision (h) of Section 11105.3 of the Penal Code. For purposes of this consent/release relating to the supplemental questionnaire, the term conviction(s) included adjudication(s) in juvenile proceedings under Welfare and Institutions Code. Completion of the attached supplemental questionnaire, successful completion of a background criminal records screening, including fingerprinting, and other background screening are required before Applicant may be deemed eligible to perform services for the City position for which he/she has applied. As the parent/guardian of, and having read the attached Supplemental Questionnaire, I hereby authorize and consent to s completion of the attached questionnaire and/or I have completed the questionnaire of behalf of. I further authorize and consent to the City of Anaheim performing a (Minor s Name) background criminal records screening, including fingerprinting, as well as any other background screening. I hereby hold harmless and release the City of Anaheim, it officers, employees, agents and volunteers from any and all claims, damages, actions and other liability relating to or resulting from completion of the above-referenced screening process. Signed this day of, 2015 (Today s Date) (Month) (Minor s Name) (Minor s Name) (Print Name of Minor) (Signature of Parent or Guardian)
CHILD/MINOR VOLUNTEER HOLD HARMLESS AND RELEASE OF LIABILITY AND MEDICAL AUTHORIZATION, has my permission to voluntary participate in the Anaheim Community (Child s Name) Services Volunteer Program. I AM AWARE THAT PARTICIPATING IN THIS ACTIVITY CAN BE HAZARDOUS, AND I AM AWARE OF THE DANGERS INVOLVED WHICH MAY PLACE THE PARTICIPANT AT RISK FOR POSSIBLE INJURY, DEATH OR PROPERTY DAMAGE AND HEREBY AGREE TO ACCEPT ON BEHALF OF MYSELF AND MY CHILD, ANY AND ALL SUCH RISKS. I AM AWARE THAT, AS A VOLUNTEER, MY CHILD IS NOT COVERED FOR ANY WORKER S COMPENSATION BENEFITS, OR ANY FIRST PARTY HEALTH AND ACCIDENT INSURANCE, BY THE CITY OF ANAHEIM. In exchange for benefits to be derived by my child s participation in the City of Anaheim s Community Services Volunteer Program, I HEREBY AGREE TO INDEMNIFY, HOLD HARMLESS AND NOT SUE THE CITY OF ANAHEIM, ITS OFFICERS, EMPLOYEES, REPRESENTATIVES, OR VOLUNTEERS for any liability, claims, or actions for injury, death, or damage to personal property arising out of or in connection with my child s participation in the City of Anaheim s Community Services Volunteer Program, activities from whatever cause including the active or passive negligence of the City of Anaheim, its officers, employees, agents, representatives, or volunteers. I hereby consent to allow my child to receive medical treatment which may be deemed advisable in the event of injury, accident or illness during my child s participation in this activity. I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A HOLD HARMLESS AGREEMENT AND A RELEASE OF LIABILITY; AND IT IS A CONTRACT BETWEEN MYSELF AND THE CITY OF ANAHEIM, WHICH I SIGN OF MY OWN FREE WILL. / / / / Signature (Parent/Guardian) Date Signature (Minor) Date Print Name (Parent/Guardian) Print Name (Minor) Address: Home Phone # ( ) Work Phone # ( ) Emergency Contact: ( ) ( ) Name Home Phone # Work Phone # FOR SITE USE: Accepted on behalf of the City of Anaheim Name: Site: Date: / / Return Original to the City of Anaheim Volunteer Project Coordinator.
CITY OF ANAHEIM COMMUNITY SERVICES DEPARTMENT FINGERPRINTING INFORMATION SHEET Transaction #: ORI: A1495 Type of Application: Employee Volunteer Job/Volunteer Location: BILLING: 140430 Mail Code: 08421 First Name: Last Name: MI: DOB: Gender: Male Female Height: Weight: Eye Color: Hair Color: City of Birth: State: Country: Address: City: Zip Code: FOR OFFICE USE ONLY Account: Completed By: Date: ATI Number: SID Number: Date SID Number was Received: Original: Personnel Specialist Yellow Copy: Supervisor Pink Copy: Staff/Volunteer P/Rec SUPPORT SVCS & CUL ART2/PERSONNEL/DOJ Rev 04/2013