Give an hour or two a week to help a child to read.

Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Phone *

(###)

###

####

Gender *

Male

Female

Prefer not to answer

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Would you like to mentor remotely or in-person? *

Remote

In-Person

No preferences

IF YOU CHOSE REMOTE MENTORSHIP, Please indicate the type of device you will use for mentorship:

Chromebook

Mac

PC

Other

Race/Ethnicity (Check all that apply) *

American Indian or Alaska Native

Asian

Black or African American

Hispanic or Latino

Native Hawaiian or Pacific Islander

Race or ethnicity not listed* (Please specify below)

Prefer not to say

White

Emergency Contact Phone Number *

(###)

###

####

Did you serve as a mentor during the last school year (i.e. anytime between October 2022 – August 2023) *

Yes

No

VOLUNTEER COMMITMENT *

I will be a good role model for students by - Conducting myself in a respectable manner - Using appropriate language (including not using the Lord’s name in vain) - Wearing appropriate clothing - Abstaining from tobacco products during tutoring sessions (in person or online), while near students, and while on tutoring premises, including parking lots - Refraining from alcoholic beverages and recreational cannabis products before and during tutoring sessions. I have read the Plan to Protect and the Statement of Faith

I AGREE

PHOTO/VIDEO CONSENTS AND RELEASES *

For the protection of all involved, I acknowledge and agree that when working online with students, I am required to video record each session using the software included in the videoconferencing platform and to send the recording to Soar Detroit after each session.

I AGREE

*

I acknowledge and agree that I may be photographed, videotaped, or recorded during other Soar Detroit activities, including but not limited to training, tutoring sessions, and interviews. These recordings and photographs may be used for the publication and dissemination of program training materials, publicity, and marketing.

I AGREE

*

Without expectation of compensation or other remuneration, now or in the future, I hereby grant to Soar Detroit, their staff, volunteers, agents, successors, licensees and assigns, the irrevocable right and license to store and use my photograph, video image, and voice, to edit or crop published images, to use or authorize the use of such photographs, audio- or video-recordings, or any portion thereof, to use my name, likeness, biographical or other information concerning me in connection therewith, for the purposes stated above in any media deemed appropriate by the organization.

I AGREE

*

I agree to hold Soar Detroit harmless against any liability, loss, or damage resulting from the use of my image, and hereby release and discharge this organization from any and all claims whatsoever in connection with such use of photographs, audio- or video-recordings. This consent is given in perpetuity and does not require prior approval by me.

I AGREE

RELEASE OF LIABILITY AND ACKNOWLEDGEMENT OF RISK *

I agree to abide by the rules and regulations of Soar Detroit. I understand that participation in this program can have associated risks. With full knowledge of the risks involved, I hereby release, waive, and discharge Soar Detroit, Sponsor, their boards, officers, and employees, from any and all liabilities, claims, demands, actions, and causes of action whatsoever, directly or indirectly arising out of or related to any loss, property damage and expenses, sickness, injury, or death, that may be sustained by me or indirectly sustained by fellow household members or my extended family, due to my volunteer participation with Soar Detroit. I understand that I am providing services as a volunteer and that I am not covered by Workman’s Compensation insurance.

I AGREE

PERMISSION TO OBTAIN BACKGROUND CHECK *

I understand that Soar Detroit, Sponsor, or other authorized third parties may conduct a background check in connection with my application to volunteer at Soar Detroit. I understand that I will not need to pay for this process. Background checks may include an inquiry into my employment history, education, general character or reputation, work experience, driving history, and criminal history and, depending on the requirements of the Sponsor, may also include fingerprinting at a location designated by the Sponsor and/or require me to divulge specific personal identifying information in order to verify records obtained. I further understand that if I am volunteering through affiliation with a third-party organization, such organizations may have a pre-existing agreement with Soar Detroit for sharing background check results. I understand that Soar Detroit may rely on all or any part of this information in determining whether to extend a volunteer position to me. I understand that the purpose of the background check is to evaluate the suitability of an applicant for volunteering and is not conducted for any other purpose. I understand that the information supplied by me will be used solely for the purposes of obtaining information, validating, or verifying information received, as a part of the background check. I understand that if I choose not to mentor a student after completing the background check, Soar Detroit may ask me to reimburse the organization for the cost of the process, up to $63.00. I, the undersigned applicant for volunteering, have read this Authorization and Release and by providing my holographic or electronic signature below, hereby authorize Soar Detroit, its representatives, agents, and authorized third parties to conduct a background check, as described herein, in conjunction with my application for volunteering and hereby release said parties from any and all liabilities related to the use, procurement or disclosure of any information provided by me or obtained about me in connection with my application for volunteering and a background check that may be performed. I further direct and authorize such third parties who may be the custodians of or may be in possession of requested records or information to disclose such information or records to Soar Detroit or their representatives and agents, in connection with this Authorization and Release. I further understand that by signing this form I am waiving all rights to any subsequent legal action.

I AGREE

*

CHECK HERE TO PROVIDE AN ELECTRONIC SIGNATURE

Date *

MM

DD

YYYY