Free Clinic:  804-556-5840
Family Services:  804-556-6260
Clothes Closet:  804-556-3627

Volunteer Application

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Volunteer Application

Volunteer Application
Thank you for your interest in volunteering at Goochland Free Clinic and Family Services! We rely on volunteers to staff our 11 programs to help our Goochland neighbors in need. Please tell us about yourself, so we can match your interest, skills, and availability to our program needs.

City
State
ZIP
Clinic volunteers and volunteers who provide direct client service must be 18 years old and no longer in high school.

When are you available to volunteer?

Check all that apply.
Tuesday evening = Clinic only
Wednesday evening = Clinic only
Saturday morning = Clothes Closet or Food Courier only
Saturday afternoon = Clothes Closet only

What program(s) would you like to volunteer in?

Check all that apply.

What type of skills and experience do you have?

Please include any skills or certifications (i.e. Spanish interpreter, CDL, CPR, electrician, contractor, etc.) you have and describe your volunteer experience.

Are you required to complete community service?

Please explain why school, court or employer is requiring hours.
How many hours are you required to complete?
When are the hours due?

How did you hear about Goochland Free Clinic and Family Services?

Why do you want to volunteer at Goochland Free Clinic and Family Services?

Who should we contact in case of an emergency?

Volunteer Agreement

By submitting this volunteer application, I agree to adhere to the following policies. 1) Confidentiality Agreement: ACCESS TO and PROTECTION of CONFIDENTIAL INFORMATION During the course of volunteering, Volunteer will have access to certain personal and valuable information of the residents of Goochland County. Such information includes, but is not limited to, personal information about the residents of the county, including medical and dental conditions, history, prescriptions, employment and financial data and other similar personal information. (Such information collectively is the “Confidential Information.”) Volunteer acknowledges and agrees that all of the Confidential Information is strictly confidential. No reference shall be made inside or outside the organization about a client’s identity, diagnosis, treatment or other confidential information about the client. This includes verifying if a person has been seen by GFCFS and giving information to the parent of a child 18 years or older. 2) Volunteer Policies: I agree to volunteer policies outlined in the Volunteer Handbook, which is available by clicking below. I represent that I am competent to contract and have read and fully understand the contents, impact and meaning of these policies.

Publicity Release

Do you give permission to Goochland Free Clinic and Family Services and its licensees and assigns to photograph me, and to publish, transmit and share in any form of media my photographs and any information based on interviews that I have given?
Goochland Free Clinic and Family Services provides equal opportunities without regard to race, color, gender, national origin, religion, sexual preference, age or disability.
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