Volunteer Application > Programs and Services

It takes more than medicine...

Volunteer Application

First Name *

Last Name *

Email Address *

Phone Number *

Address 1 *

Address 2

City *

Zip Code *

Date of Birth *

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Please select the area(s) in which you have an interest in volunteering *

Camp Counselor

Events

Office & Administrative Assistance

Teaching & Special Skills Instruction

Have you ever been charged of a criminal offense (misdemeanor or felony) that resulted in a finding of anything other than "not guilty"? *

Yes No

This includes those which have been judicially ordered sealed, expunged, or statutorily eradicated.

If you answered 'yes' to the above question, please explain.

Please tell us how you heard about HoG. *

Emergency Contact Name *

Emergency Contact Phone Number *

Emergency Contact Relationship *

Briefly explain why you chose to apply and how you hope to benefit from the experience *

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Volunteer Release and Waiver of Liability *

In consideration of being permitted to participate as a volunteer for Hemophilia of Georgia, Inc. (“Hemophilia of Georgia”), I waive all claims against Hemophilia of Georgia, Inc., their officers, directors, agents, employees, volunteers, or any other parties contracted by them for services provided during or in connection with these activities with which I participate. I understand that I will be responsible for any damages, injuries, and/or illnesses that may occur to me during or as a result of my participation in this activity. My services to Hemophilia of Georgia, Inc. are on a voluntary basis, and I am not entitled to nor shall I receive any compensation or employee benefits of any kind. I hereby agree that Hemophilia of Georgia may verify the information that I have provided in this application by contacting persons or organizations named in this application, and/or by contacting any other person or organization that may have information concerning me. For overnight events and youth camps, this will include a criminal background check. I hereby release and hold harmless from liability Hemophilia of Georgia for requesting information about me in connection with this application and any person or organization that provides information about me in connection with this application. I also agree to hold harmless Hemophilia of Georgia, the officers, employees, and volunteers thereof.

Check below if you agree.

Volunteer Photo Waiver/Media Release *

I give Hemophilia of Georgia, permission to use photographs or other images of me/my child in public relations activities and promotional materials including, but not limited to, videotapes, pamphlets, and brochures. I give permission for my photographs to be posted on Hemophilia of Georgia’s website, and I further acknowledge that Hemophilia of Georgia shall have all rights of copyrights in and to such photographs and videotapes and may exploit such copyright fully. I release and waive all rights and interests in and to such materials.

Check below if you agree.

Volunteer Expectations & Responsibilities *

Volunteers at Hemophilia of Georgia may be asked to participate in a variety of activities/events to support the various programs and services offered. Activities include, but are not limited to, physical activities such as biking, canoeing, horseback riding, ropes course, archery, tennis and swimming. Many programs are held outdoors, and volunteers may be expected to participate in the event regardless of current weather conditions. All volunteers at Hemophilia of Georgia may be expected to lift and carry program supplies and materials up to 40 lbs. If you have any condition that might interfere with your ability to perform the tasks described above, please let us know.

Volunteers are liaisons between Hemophilia of Georgia and the public. Always be aware that you are a representative of Hemophilia of Georgia at this event and conduct yourself accordingly. You may be assigned to work in an area where celebrities are present. NEVER solicit autographs or personal photographs. Our supporters value their anonymity at our events.

Volunteers should never post photos or identify participants by name on the Internet. This includes blogs, personal web pages, photo sharing sites such as SnapFish and Flickr, and social networking sites such as MySpace and FaceBook.

Check below if you agree.

Alcohol Waiver *

Participant understands and agrees to the following: 1. alcoholic beverages may be provided at this event, 2. the Participant has no obligation to consume any such beverages and will refrain from doing so if under the age of 21, and 3. Hemophilia of Georgia assumes no responsibility or liability for Participants who drink alcohol.

THE PARTICIPANT ACKNOWLEDGES AND AGREES THAT OPERATING A MOTOR VEHICLE WHILE UNDER THE INFLUENCE OF ALCOHOL IS ILLEGAL AND PRESENTS SUBSTANTIAL RISK TO THE PARTICIPANT AND TO OTHERS, INCLUDING RISK OF DAMAGE TO PERSONAL PROPERTY, PERSONAL INJURY, OR DEATH. HEMOPHILIA OF GEORGIA, INC. STRONGLY ENCOURAGES THE PARTICIPANT NOT TO DRIVE HIM OR HERSELF OR OTHER INDIVIDUALS TO OR FROM THE EVENT AND TO MAKE ALTERNATIVE ARRANGEMENTS FOR TRAVEL IF THE PARTICIPANT PLANS TO CONSUME ALCOHOLIC BEVERAGES AT THE EVENT, AND THE PARTICIPANT AGREES HE OR SHE WILL REFRAIN FROM DRIVING AND WILL MAKE ALTERATIVE TRAVEL ARRANGEMENTS IF IMPAIRED.

Check below if you agree.

Confidentiality *

It is the policy of Hemophilia of Georgia that the confidentiality of those affected by a bleeding disorder be strictly maintained. By participating in this event, the Participant agrees that he or she will not use any information obtained as a result of his or her participation, including without limitation any information regarding other event attendees, for any purpose other than those stated in the program.

Check below if you agree.

Covid-19 Waiver *

It is the policy of Hemophilia of Georgia that responsible measures be taken to prevent the spread of COVID-19 during these Hemophilia of Georgia sponsored events. All participants will be required to wear a cloth face covering at all times, which may only be removed if they are actively speaking, eating, drinking. All participants must remain a distance of at least 6 feet from each other and may be asked to stand outside if distance cannot be maintained safely indoors. Hemophilia of Georgia does not, however, guarantee that you will not become infected with COVID-19, and participating in this event could increase your risk of contracting COVID-19 as well as the risk you could infect others, including your family members, with COVID-19.

Check below if you agree.

I have read and understand this policy and agree to abide by it. Failure to abide by these expectations may result in termination of my volunteer service for Hemophilia of Georgia. *

Please type your name below.

Today's date *