grant permission to Yakima Valley Memorial to verify and
obtain information needed to process my volunteer application.
I hereby release all
agencies contacted from
any and all liability of damages for providing the information requested.
Further, I certify that the above information is true and correct to the best
of my knowledge. I understand that misrepresentation or omission of facts is cause for rejection or
termination of placement. Placement is contingent upon a satisfactory Criminal History Report. I understand
that this application does not create a contract of employment or promise of future employment. I understand
that my request to volunteer is voluntary, unpaid, and can be terminated at any time at the option of either
the agency or myself. I understand that my ID badge is my responsibility. I will not loan it to anyone,
and will report immediately if it is lost or stolen. I will return it when I am no longer a volunteer
My typed name below verifies that I have
agree to comply with the above Confidentiality, HIPAA, and Acceptable Use
Policies. I understand my responsibility in protecting these rights. My typed
name below shall have the same force and effect as my written signature.