Referral and Affiliation
Area of Interest and Availability
Work and Volunteer History
I affirm that the information provided on this application is true and complete to the best of my knowledge. I understand that the information provided on this form is to be used only by Catholic Charities for the purpose of its' volunteer program.
atholic Charities of Louisville, Inc. must safeguard their clients' right to privacy by treating and protecting all information as CONFIDENTIAL. Therefore, I shall safeguard and treat as confidential, any and all information (whether acquired through verbal communication, written records or observation) regarding any client, which I may receive through my affiliation with Catholic Charities of Louisville, Inc as a volunteer. I have read and understand this STATEMENT OF CONFIDENTIALITY
I hereby allow Catholic Charities of Louisville, Inc. the right to use photos, videos, text or interviews using my likeness or voice. I understand that these may be used more than once in different publications approved by the agency and I will not hold Catholic Charities of Louisville, Inc. liable for any monetary remuneration to me for their use.
I also understand that the provision of services to me by Catholic Charities of Louisville, Inc. is neither contingent on my willingness to provide this consent, nor my participation in any other activities I may be invited to contribute in person on behalf of the agency.
I may revoke this consent at any time by notifying Catholic Charities of Louisville, Inc. of that intention in writing.
Parental/Guardian Consent (if applicant is under the age of 18)
I hereby consent to this minor child's participation in volunteering with Catholic Charities. I am not aware of any physical or medical condition that would interfere with the child's ability to participate. If the child is injured or becomes ill and neither I nor any other parent/guardian identified below can be reached, I give Catholic Charities permission to seek medical attention for the child.
Emergency Contact Information