Volunteer Application Form – Serve the City Belgium

Dear volunteer, thank you for your interest in Serve the City. For insurance and legal reasons, please read and fill in the form below if you are planning on attending one of our projects or volunteering event. This form must be filled once a year.

You can use the navigation on the left to go from one section to the other
1. Organization
Name
Address
Telephone
E-mail
Altruistic Goal
Social-profit organization acting as a matchmaker between volunteers and NGOs that serve the homeless, asylum seekers, children in need, the elderly, victims of abuse, and people with disabilities.
Legal Status
Emergency Contact
2. Insurances
Guarantees
Company
Policy number
3. Expenses paid to volunteers
Serve the City does not pay a salary to volunteers. The organization pays the real costs, when receiving the right receipts as a proof of expense encountered while volunteering. Volunteer understands that the scope of Volunteer's relationship with Serve the City is limited to a volunteer position and that no compensation is expected in return for services provided by Volunteer; that Serve the City will not provide any benefits traditionally associated with employment to Volunteer; and that Volunteer is responsible for his/her own insurance coverage in the event of personal injury or illness as a result of Volunteer's services to Serve the City.
4. Obligation of Discretion
According to article 458 of the criminal Code "Doctors, surgeries, officers of health, pharmaceutical chemists, mid wives and all other persons that because of their profession, get to know secrets trusted by those people, and outside the case that the law obliges them to announce it, are punished with imprisonment of 8 days-6 months and a fine of 100-500 euro." The words “all other persons” in the list can also apply to a volunteer in cases where a form of secrecy is required. Volunteer understands that the scope of Volunteer's relationship with Serve the City is limited to a volunteer position and that no compensation is expected in return for services provided by Volunteer; that Serve the City will not provide any benefits traditionally associated with employment to Volunteer; and that Volunteer is responsible for his/her own insurance coverage in the event of personal injury or illness as a result of Volunteer's services to Serve the City.
5. Volunteer Details
Name / Naam / Nom*
First Last
Address / Adres / Adresse*
Street Address City ZIP / Postal Code Country
Phone / Telefoon / Téléphone*
Email*
Altruistic or personal goal for volunteering*
Persoonlijkemotivatieomvrijwilligerswerktedoen
Objectif personnel pour faire du bénévolat
Status in Belgium / Status in België / Statut en Belgique*
6. Volunteer Guidelines
- Please help us to create a positive serving environment! - Be respectful of those you are serving - Respect your project leader and team - Contact us if your schedule changes and you have to cancel your participation - Report any problems or issues to your Project Leader - Respect privacy and confidentiality of the people and organisation you are serving - Social media and photo policy: don’t take pictures of children, and ask permission of adults before taking a picture or video
7. Waiver and Release
I, the Volunteer, release and forever discharge and hold harmless Serve the City 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 the services I provide to Serve the City. I understand and acknowledge that this release discharges Serve the City from any liability or claim that I may have against Serve the City with respect to bodily injury, personal injury, illness, death, or property damage that may result from the services I provide to Serve the City or occurring while I am providing volunteer services. As a volunteer with Serve the City, you understand that you may be photographed, filmed, or videotaped and you hereby give Serve the City the unqualified right to take pictures and/or recordings of you and grant the perpetual right to use your likeness, image, photo (collectively, “image”), without compensation, for broadcast or exhibition in any medium and to put the finished pictures/recordings to any legitimate use without limitation or reservation. You hereby waive, release and forever discharge Serve the City from and against any and all claims or actions arising out of or resulting from any use of your image. Serve the City shall not be obligated to use, and may elect not to use, your image. If you would like to volunteer and choose not to allow the use of your image, please send an email to Serve the City at info@servethecity.be with your name and a copy of your photo ID.
Date*
Volunteer Signature*

1. Organization

2. Insurances

3. Expenses paid to volunteers

4. Obligation of Discretion

5. Volunteer Details

6. Volunteer Guidelines

7. Waiver and Release