Volunteer Form

Contact Info

Suffolk Y JCC Member?
Language Proficiency (other than English):
Area of volunteer interest (check all that apply)
*NYS Drivers License Required

Availability:

Time
Time

Before beginning a volunteer task, you will have a conversation with the Volunteer Coordinator to make sure that the task fits your interests and abilities. Some assignments may require additional screening, such as background checks or further reference checks. Some assignments may begin only after successful completion of appropriate training.

If your volunteer task requires it, please provide two personal references (not a relative):

Statement of Confidentiality

I understand that in assuming my responsibilities as a volunteer for Suffolk Y JCC, I may have access to information which is proprietary to Suffolk YJCC and/or personal health information about program participants. In keeping with the professional standards and ethics of the Suffolk Y JCC, I will consider all such information strictly confidential and will not sure, copy, discuss or distribute such confidential information with any unauthorized person inside or outside of the agency.

Statement of Permission for Publicity

I voluntarily give permission to Suffolk Y JCC and representatives of the press to use information about me and photographs of me for information, fundraising and/or advertising purposes  to describe the work of Suffolk Y JCC without compensation. Examples of such informational materials would include, but not limited to, television, newspaper or magazine articles, electronic media, video, or brochures. In giving this consent, I hereby release Suffolk Y JCC, its Directors, employees, agents and volunteers from liability for any violations of any personal or proprietary right I may have in connection with the above use of photographs