Volunteer Application

Volunteer Application

  • Date Format: MM slash DD slash YYYY
  • If different
  • Demographic Information

  • Other Information

  • If yes, please complete next line
  • MondayTuesdayWednesdayThursdayFriday 
  • Please include name, relationship and telephone number
  • CONFIDENTIALITY AGREEMENT AND WAIVER OF LIABILITY

    As a volunteer for programs offered and administered by Health Services of North Texas, Inc. (HSNT), I do hereby accept the conditions designated below of participation in any such programs. As one of the conditions, I specifically release HSNT, its volunteers, agents, representatives, employees, and independent contractors from any claims or liabilities of any kind whatsoever, including but no limited to those claims which are actual or unknown, arising from or related to my participation in activities of HSNT. Further, I understand the information shared with me in the course of my work for HSNT is to be held in strictest of confidence and is not to be shared or discussed outside of support meetings or with any person not employed by HSNT. I understand that I must and will assume any and all criminal and civil liability for any breach of confidence in which I am involved.
  • Date Format: MM slash DD slash YYYY
  • Please fill out the Verifyi Background Release Form