Family Development Services: Volunteer Application

Please complete this form to help us design an exciting individual volunteer plan for you. All fields are required unless otherwise marked.

Basic Info First Name:
Last Name:
Date of Birth:
Gender:

Contact Info (Email address not required) Daytime Phone:
Evening Phone:
Email Address:

Home Address Street:
City:
State:
Zip:

Mailing Address (if different from above) Street:
City:
State:
Zip:

Emergency Contact Name:
Phone:

Job Specifics How did you hear about us?

Preferred Type:
Preferred Jobs:
Preferred Location:

Can we contact you about other volunteer opportunities Yes No

Comments:

Family Development Services Confidentiality Policy
All families have a right to confidentiality. This means that information about Head Start children and their families cannot be shared with outside agencies without the written permission of the parent or legal guardian.

Confidential information is any personal data: written, computerized (electronic), or verbal information disclosed by a family member in order to secure and maintain services. This information may include, but is not limited to: application information, health histories, medical exams, family background, screening and assessment data, teacher/parent observations, home visit reports, or child abuse/neglect reports.

Information can only be shared within Head Start on a “need to know” basis. Informal conversation regarding personal information in the presence of staff, parents, volunteers, visitors, etc. will be considered a violation of confidentiality and privacy. Any person privileged to information should be conscious of where, when, and in front of whom Head Start children and families are discussed. Disclosure without written permission is unethical and illegal. Even if children’s names are not used, any inappropriate discussion that makes children and their families identifiable is a violation of privacy.

This policy extends to information that might be obtained regarding Family Development Services’ employees and/or applicants, dependent upon the nature of the volunteer position.

I have read the above policy and agree to comply.