Volunteer Registration Form
THIS ONLY NEEDS TO BE COMPLETED ONCE
If you have previously registered with us, you don't need to fill out this form again! You just need to
click this link to go to the login page instead
, or if you are having trouble, please
get in touch
.
Thank you for your interest in volunteering with Catalyst Partnerships. We are glad to partner with you to help people in the community in practical ways!
Our volunteers are our greatest asset, and we have a great time working together on our projects! To join our crew of volunteers, please fill-out this form.
Basic Details
*
First Name:
*
Last Name:
Date of birth:
/
/
(mm/dd/yyyy)
*
Email Address:
Address
Line 1:
Line 2:
City:
State:
Please select a state code...
AK : Alaska
AL : Alabama
AR : Arkansas
AZ : Arizona
CA : California
CO : Colorado
CT : Connecticut
DC : District of Columbia
DE : Delaware
FL : Florida
GA : Georgia
HI : Hawaii
IA : Iowa
ID : Idaho
IL : Illinois
IN : Indiana
KS : Kansas
KY : Kentucky
LA : Louisiana
MA : Massachusetts
MD : Maryland
ME : Maine
MI : Michigan
MN : Minnesota
MO : Missouri
MS : Mississippi
MT : Montana
NC : North Carolina
ND : North Dakota
NE : Nebraska
NH : New Hampshire
NJ : New Jersey
NM : New Mexico
NV : Nevada
NY : New York
OH : Ohio
OK : Oklahoma
OR : Oregon
PA : Pennsylvania
RI : Rhode Island
SC : South Carolina
SD : South Dakota
TN : Tennessee
TX : Texas
UT : Utah
VA : Virginia
VT : Vermont
WA : Washington
WI : Wisconsin
WV : West Virginia
WY : Wyoming
AA : US Military Mail AA
AE : US Military Mail AE
AP : US Military Mail AP
AS : American Samoa
FM : Micronesia
GU : Guam
MH : Marshall Islands
MP : Northern Mariana Islands
PR : Puerto Rico
PW : Palau
VI : Virgin Islands
Other (Enter/View below...)
Zip code:
Country:
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua
Argentina
Armenia
Aruba
Ascension Island
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Barbuda
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia
Botswana
Brazil
British Virgin Islands
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde Islands
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos-Keeling Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Democratic Republic of Congo
Denmark
Diego Garcia
Djibouti
Dominica
Dominican Republic
East Timor
Easter Island
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Faeroe Islands
Falkland Islands
Fiji
Finland
France
French Antilles
French Guiana
French Polynesia
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Israel
Italy
Ivory Coast
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Kosovo
Kuwait
Kyrgyz Republic
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali Republic
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte Island
Mexico
Micronesia
Midway
Moldova
Monaco
Mongolia
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
Nevis
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Republic of Ireland
Reunion Island
Romania
Russia
Rwanda
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Korea
Spain
Sri Lanka
St Helena
St Kitts
St Lucia
St Pierre and Miquelon
St Vincent and Grenadines
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
US Virgin Islands
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Wake Island
Wallis and Futuna Islands
Western Sahara
Western Samoa
Yemen
Yugoslavia
Zambia
Zanzibar
Zimbabwe
Phone Numbers
Cellphone:
Home:
Other Details
Parent/Guardian's Name
(?)
Parent/Guardian's Phone
(?)
Parent/Guardian's email
(?)
Specific Skills - Please Describe
(?)
How did you hear about Catalyst?
(?)
Your children volunteering with you? Names + DOBs
(?)
Emergency contact name & phone number
(?)
Any medical conditions, allergies, or medications?
Yes
No
If "Yes", please describe
(?)
Are you signing-up for a specific project/date(s)?
Yes
No
If "Yes", please describe
(?)
Do you have personal medical insurance?
(?)
Yes
No
If so, Please list Carrier
(?)
Volunteer Group Affiliation
None
Bay Club
Centrex
Green Group
Highland Helpers
Home Depot
JE Dunn
Kaiser Permanente
nVoicepay
Renewal by Andersen
Shepherd's Door / Portland Rescue Mission
The Harbor / Portland Rescue Mission
Transitional Youth
Other
If other please write-in
(?)
Church Affiliation
None
Abundant Life (Happy Valley)
Abundant Life (Sandy)
Athey Creek (West Linn)
Beaverton Christian (Beaverton)
The Bridge
Catalyst NW
Community of Hope Lutheran (Wilsonville)
Eastridge Church
Grace Chapel (Wilsonville)
Grace Point (Tigard)
Joyful Servant Lutheran (Newberg)
Kaleo Covenant
Living Hope (Aloha)
North Plains Christian (N. Plains)
Northshore Christian (Everett, WA)
Northwest Christian (Tigard)
Riverbend AJC (Bend)
River West (Lk. Oswego)
Stone Creek Christian (Oregon City)
Sunset Presbyterian (NW Portland)
Westside AJC (Tigard)
West Portland UMC (SW Portland)
26 West AJC (Hillsboro)
Other
If other please write-in
(?)
Consent
* I consent to my personal information being stored and used by Catalyst for administration purposes. I understand that I can withdraw my consent at any time. Further information is available in the
privacy policy
.
* I consent to Catalyst contacting me with updates. I understand that I can withdraw this consent at any time.
* Medical Insurance Waiver
TICK THIS BOX TO VERIFY THAT YOU UNDERSTAND AND AGREE TO THIS: Volunteer understands that Catalyst does not carry health, medical, or disability insurance coverage for any Volunteer; and that, in the event that I/my child am/is injured in any way, any personal medical and hospitalization insurance available to me/my family will provide sole coverage. If I do not have medical insurance, I accept all responsibility in case of injury/accident involving me/my child. I also understand that Catalyst 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, as detailed in the attached Voluntary Activities Participation Waiver, Release of Liability, & Medical Treatment Authorization.
* Voluntary Activities Participation Waiver
I understand and acknowledge that my involvement in this endeavor with Catalyst Partnerships, its agents and contractors, and any partnering organizations, hereafter referred to as ‘Catalyst,’ is voluntary. I give Catalyst, and any other partnering organization, permission to verify my information, and perform personal & criminal background checks. I understand that the background check process, or any false or misleading information I have given, may disqualify me from involvement. I also voluntarily submit myself to the supervision of Catalyst staff, officers, agents, employees, volunteers, etc., for all activities which are part of this project. I also give Catalyst the irrevocable right and unrestricted permission to use and/or publish photos and/or video images of/including me, for purposes of art, display, advertising, editorial use, or any other lawful purpose, and waive any right I may have to inspect and approve the finished product of any piece that may use such. I hereby acknowledge and understand that I am responsible for providing my own transportation to/from Catalyst events. Catalyst is in no way responsible for, nor does Catalyst assume liability for, any injury or loss resulting from my transportation.
I understand and acknowledge that Catalyst activities, by their very nature, pose the potential risk of serious injury/illness. Some of the injuries/illnesses which may result from participating in these activities include, but are not limited to, the following: Sprains, fractured bones, unconsciousness, head and/or back injuries, paralysis, activity related injury/illness, loss of eyesight, communicable diseases, death. This list is not intended to be inclusive of all injuries that may occur. In the event of accident or illness to me/my child, I do hereby consent to whatever x-ray examination, anesthetic, medical, surgical or dental diagnosis or treatment and hospital care considered necessary in the best judgment of the attending physician, surgeon, or dentist and performed under the supervision of a member of the medical staff of the hospital or facility furnishing medical or dental services. In the event that my child requires such treatment, reasonable efforts will be made to contact me the parent/guardian of the minor; however, if I cannot be reached, I hereby consent to such treatment. Further, I agree that Catalyst and its personnel, agents, or volunteers, or any other person or entity associated with these Activities, are not personally responsible or liable for any claim arising from any consent given in good faith in connection with diagnosis or advised treatment.
I/my child understand(s) that Catalyst DOES NOT CARRY HEALTH, MEDICAL, OR DISABILITY INSURANCE TO COVER ME/MY CHILD for any accidents/injuries to me/ my child, or to any other volunteer. I understand that, in the event that I/my child am/is injured in any way, any personal medical and hospitalization insurance available to me/my family will provide sole coverage. I/my child voluntarily elect(s) to participate in Catalyst Activities. I agree to assume any and all liability and responsibility for any and all potential risks which may be associated with participation in such Activities or any activities incidental thereto. I hereby voluntarily exempt and relieve, on behalf of myself and my heirs, executors, administrators and assigns, Catalyst, its officers, agents, servants, employees, volunteers, or any other person or entity associated with these activities, from any liability or responsibility for any property damage, personal injury, bodily injury, or wrongful death that I/my child might sustain which is incident to and/or associated with preparing for and/or while participating in any activity in any way connected with Catalyst activities, including travel to and from activity locations, whether same shall arise by the negligence of any of said persons, or otherwise. I acknowledge that I have carefully read and understand this Voluntary Activities Participation Waiver, Release of Liability and Medical Treatment Authorization and that I agree to its terms and conditions.
POLICIES FOR MINORS: Children under 15 must be accompanied and supervised at all times by a parent/guardian, or other responsible adult designated by parent/guardian and approved by Catalyst leader. May not engage in hazardous activities (such as use of power tools), if under 12, or, if between 12 & 18, only under supervision of Catalyst leader or responsible adult designated by Catalyst leader. May never be alone with any non-family adult under any circumstances.