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Achim B'Yachad
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New Jersey Region
Join Chai Lifeline,
And Change a LIfe.
Maybe Even your own.
: Choose a Region :
NY
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Project Chai
iShine Five Towns
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iShine Westchester Riverdale
iShine NY Achim Byachad
iShine Midwest
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iShine Westcoast
Kidz/Tweenz Konnect Lakewood
Minors
Under 18 years of age
Adults
ages 18+
Thank you for expressing interest in volunteering for Chai Lifeline's Mid-Atlantic Region.
Registration is now closed and will be reopening again on December 15th 2020.
If you feel that you have reached this message in error, or wish to be added to our waitlist, please email
Yardena Gardyn
at
ygardyn@chailifeline.org
.
Contact Information
:: Title ::
Mr.
Mrs.
Ms.
Miss
Dr.
:: State ::
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Marital Status
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Do you have a driver's license?
Yes
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Reference
Please provide us with a faculty member at your school for a character reference.
Emergency Information
Employment Information
Volunteer Experience
:: Select ::
Outside US & Canada
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
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Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland
Northwest Territories
Nova Scotia
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon Territory
Volunteer Interests
Do you have a relevant degree or professional license/certification?
Yes
No
Do you have previous experience with loss, trauma and bereavement?
Yes
No
Are you aware of any limitations which might interfere with your being on call as a crisis volunteer?
Yes
No
Have you ever been convicted of any crime, including sex-related or child abuse related offenses in any state or country?
Yes
No
If you have a professional license, have you ever been required to surrender your license by the licensing board or professional ethics body?
Yes
No
N/A
Have you ever been found guilty of violation of professional ethics codes, professional misconduct, or unprofessional conduct, in any state or country?
Yes
No
Waiver And Confidentiality Clause
Release and Waiver. Volunteer (and Guardian) does hereby release and forever discharge and hold harmless Chai Lifeline and its successors and assigns from any and all liability, claims, and demands of whatever kind or nature, either in law or in equity, which arise or may hereafter arise from Volunteer's Activities with Chai Lifeline. Volunteer (and Guardian) understands that this Release discharges Chai Lifeline from any liability or claim that the Volunteer (or Guardian) may have against Chai Lifeline with respect to any bodily injury, personal injury, illness, death, or property damage that may result from Volunteer's Activities with Chai Lifeline, whether caused by the negligence of Chai Lifeline or its officers, directors, employees, agents, or otherwise. Volunteer (and Guardian) also understands that Chai Lifeline does not assume any responsibility for or obligation to provide financial assistance or other assistance, including but not limited to medical, health, or disability insurance in the event of injury or illness. Medical Treatment. Volunteer (and Guardian) does hereby release and forever discharge Chai Lifeline from any claim whatsoever that arises or may hereafter on account of any first aid, treatment, or service rendered in connection with the Volunteer's Activities with Chai Lifeline or with the decision by any representative or agent of Chai Lifeline to exercise the power to consent to medical or dental treatment as such power may be granted and authorized in this release Assumption of Risk. Volunteer (and Guardian) understands that the Activities with Chai Lifeline include work that may be hazardous (that is, can cause serious physical injury or death) to the Volunteer, including, but not limited to, transportation to and from the Activities. Volunteer (and Guardian) hereby expressly and specifically assumes the risk of injury or harm in the Activities and releases Chai Lifeline from all liability including that for all injuries, illness, death, or property damage resulting from the Activities and/or Volunteer's negligence. Volunteer (and Guardian) also agrees to indemnify Chai Lifeline for any injury they cause another. Insurance. Volunteer (and Guardian) understands that, except as otherwise agreed to by Chai Lifeline in writing, Chai Lifeline does not carry or maintain health, medical or disability insurance coverage for any Volunteer. Each volunteer is expected and encouraged to obtain his or her own medical or health insurance coverage. Photographic Release. Volunteer (and Guardian) does hereby grant and convey unto Chai Lifeline all right, title and interest in any and all photographic images and video or audio recordings made by Chai Lifeline during the Volunteer's Activities with Chai Lifeline, including, but not limited to, any royalties, proceeds, or other benefits derived from such photographs or recordings. Other. Volunteer (and Guardian) expressly agrees that this Release is intended to be as broad and inclusive as permitted by the local and state laws, and that this Release shall be governed by and interpreted in accordance with the local and state laws . Volunteer (and Guardian) agrees that if there is any dispute with Chai Lifeline, it will be resolved by binding arbitration in that state, based upon the rules of the American Arbitration Association and local and state law. Volunteer (and Guardian) agrees that in the event that any clause or provision of this Release shall be held to be invalid by any court of competent jurisdiction, the invalidity of such clause shall not otherwise affect the remaining provisions of this Release which shall continue to be enforced. As a Chai Lifeline volunteer, I understand that in the course of my contacts with families served by Chai Lifeline, I might learn privileged and confidential information that is of a highly personal nature. Examples of such information might be but are not limited to; medical condition and treatment, finances, living arrangements, employment, identifying information and relationships among family members. I understand that all such information must be treated as confidential. I agree not to disclose any information I learn about patients and their family members to anyone, except a Chai Lifeline staff member. I will also make certain that any disclosures are made in a private setting in which no one can overhear any information that is conveyed. I understand unauthorized disclosures are considered grounds for immediate termination of volunteer status.
I AGREE TO THESE TERMS AND POLICIES
