Applicant's Certification and Agreement

Please read and sign the document below.

I certify that the facts set forth in this volunteer application are true and complete to the best of my knowledge, and I authorize Free Women's Clinic of Pulaski to verify their accuracy and to obtain reference information concerning my character and capabilities.

I release Free Women's Clinic of Pulaski and any person or entity providing such reference information from any and all liability relating to the provision of such information or relating to any decisions made based upon such information.

I give permission to the Free Women's Center to conduct a criminal background check to the extent that my volunteer duties may involve direct interaction with minors.

If I become a volunteer at the center, I agree to fully adhere to its policies, procedures, and rules, including those rules relating to maintaining patient confidentiality.

I recognize that, as a volunteer, I will serve in a different role than employees of the center, and I am not seeking, nor expecting to receive, any compensation or other benefits in return for any volunteer services which I may provide for this ministry.

Volunteer Application