Address

P.O. Box 18782
Indianapolis, IN 46218
nwad.net

Volunteer Application

Volunteer form for Nurturing Weapons & Dreams

If you have questions, please contact:
Dawn Crittenden, CEO, Event Coordinator & Volunteer Engagement
contactus@nwad.net

Volunteers for most assignments must be 18 years of age.
We have some opportunities for those who are 16 or 17.

Volunteer Information

Emergency Contact Information

Areas of Interest

Please indicate which opportunities you are interested in.

*Note certain volunteer opportunities are limited and may not be available at this time. We will fill volunteer positions based on organizational need.

Virtual Opportunities
Direct Service
General (Days & Times vary)
Offsite Volunteering (good for groups)
One Time Specific Event
Have you been vaccinated for Covid-19? * *

Consent to Background Check

Nurturing Weapons And Dreams will conduct a background check on all potential volunteers. Nurturing Weapons and Dreams works with those convicted of criminal offenses that we believe will NOT put our consumers, current employees, the organization or the community we serve are at risk. Nurturing Weapons And Dreams may share background information internally, if deemed necessary. Please provide this information, which is necessary to complete your background check.

Sex

HIPAA AND CONFIDENTIALITY

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires the complete privacy and confidentiality of the Protected Health Information (PHI) of our consumers.

HIPAA GUIDELINES
• Never photograph a consumer. Do not post names, identifying information or photos on social media or via text (including Snapchat, Instagram and Facebook).
• Never talk about specific consumers or disclose any PHI such as consumer’s name or diagnosis when discussing your experience at Nurturing Weapons & Dreams.
• If you see a consumer in public or coincidentally know a consumer socially, never disclose publicly that you know the consumer or that they receive services at Nurturing Weapons & Dreams.
• Only seek from staff the minimal amount of information needed to carry out your assignment.
• Do not record consumer’s PHI such as name, date of birth, phone number or social security number on any forms or reports that you may need to turn into your school or organization.
• You may only access PHI of consumers for whom you are volunteering. Do not ask or seek information about other consumers.
• Be aware of surroundings when discussing a consumer or asking staff for additional information. All communication should take place in a private location.
• When disposing of any documents containing PHI, use the “Shred-It” containers.
• If you have any questions regarding HIPAA or situations regarding the care and management of the PHI of our consumers, please contact our Privacy Officer, Shadonna Crittenden, at 317-515-2920.

CONFIDENTIALITY AGREEMENT
I understand that while I am a volunteer at Nurturing Weapons & Dreams I may be given a volunteer assignment where I have access to Protected Health Information (PHI). PHI encompasses all information about the consumer, including:

• Name
• Medical Record Number
• Date of Birth
• Pictures
• Social Security Number
• Address
• Email Address
• Telephone or Fax Number
• Diagnosis
• Behavioral Plans
• Clinical Information
• Lab Reports

I understand that I am to keep in strictest confidence any information that I may gain in the course of my volunteer assignments.

I agree to refrain from any communications or action which could identify or cause harm to the consumers about whom I may receive information during the course of my assignment here at Nurturing Weapons & Dreams.

I understand that breach of this confidentiality will result in the termination of my volunteer status and may result in subsequent civil and/or criminal penalties.

VOLUNTEER HANDBOOK

I understand that a copy of the Nurturing Weapons & Dreams Volunteer Handbook is located on the Nurturing Weapons & Dreams website. I acknowledge that the current Volunteer Handbook supersedes any and all prior handbooks or policies of Nurturing Weapons & Dreams. I understand that the information contained in the Volunteer Handbook constitutes management guidelines only, which may be added to, deleted or changed from time to time at the discretion of Nurturing Weapons & Dreams. I acknowledge that I accept full responsibility for acting in accordance with the policies contained in the Volunteer Handbook.

UNIVERSAL PRECAUTIONS & EXPOSURES

Wash your hands frequently. Do not touch anything that may be contaminated with blood or bodily fluids. Do not give first aid or CPR. If you are accidentally exposed to blood or bodily fluids of any kind, immediately notify staff and ask for assistance. Remove any contaminated clothing without contaminating the rest of your body. Such clothing must be laundered or disinfected before it can be taken home. Wash any exposed area of your body immediately with soap and running water. If your eyes, nose, or mouth are splashed with blood or body fluids, flush them with large amounts of running water. Report your exposure immediately to the Nurturing Weapons & Dreams staff and the Volunteer Coordinator.

AUTHORIZATION TO USE VOLUNTEER LIKENESS

I understand and agree that any narratives, depictions, pictures, film, photographs, audio-visual or sound recordings, or testimonials of me made by Nurturing Weapons & Dreams or its respective employees and agents may be used by Nurturing Weapons & Dreams and those acting with its permission for the purpose of illustration, broadcast, or testimonial in connection with the work of Nurturing Weapons & Dreams and that these materials may be released to the general public. I assign to Nurturing Weapons & Dreams all of my rights to these materials.

APPLICANT STATEMENT AND WAIVER OF RESPONSIBILITY

I acknowledge and agree that I am aware of the potential risks involved in participating in volunteer activities on behalf of Nurturing Weapons & Dreams. I exempt and release Nurturing Weapons & Dreams, its officers, agents, servants and employees from any and all liability claims, demands or actions or causes of action whatsoever arising out of participation in volunteer activities on behalf of Nurturing Weapons & Dreams.

As a volunteer, I understand that I will earn no wages, benefits or monetary compensation and I will not be entitled to unemployment insurance benefits upon the termination of this agreement or as a result of the service(s) I provide to Nurturing Weapons & Dreams. I understand that false or misleading information given in my application or interviews may result in discharge. Also, I understand that I am required to abide by all requirements of the programs, policies, and procedures of Nurturing Weapons & Dreams.

I consent to Nurturing Weapons & Dreams use of all information provided during the application process in obtaining criminal history reports. I understand that I have the right to review and challenge any negative information that would adversely impact a decision to offer volunteerism. I understand that I will have a reasonable opportunity to clear up any mistaken information reported within a reasonable time frame established at the discretion of Nurturing Weapons & Dreams. I further understand that upon request, I will be provided with the name, address, and telephone number of the reporting agency as well as the nature, substance, and source of all information obtained.

This agreement is effective and binding from the date of application. I have read and understood this agreement.