Emergency Contact Information
*All volunteer hours are between 8:00 a.m. and 1:00 p.m.
Media Release
I hereby authorize Meals on Wheels of Linn, Benon, Lincoln (MOW LBL) operating under Oregon Cascades West Council of Governments (OCWCOG) permission to use my image in any and all of its publications including but not limited to all MOW LBL and OCWCOG's printed and electronic publications, and/or official website. I understand and agree that any photograph and/or video using my likeness will become property of MOM LBL and/or OCWCOG and may not be returned.
I acknowledge that since my participation with MOW LBL/OCWCOG is voluntary, I will receive no financial compensation.
I hereby irrevocably authorize MOW LBL and OCWCOG to edit, alter, copy, exhibit, publish or distribute this photo and/or video, with or without my name, for purposes of publicizing MOW LBL and/or OCWCOG programs or for any other lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph and/or video.
I hereby hold harmless and release and forever discharge MOW LBL, OCWCOG, and any representative of its member jurisdictions from all claims and causes of actions which I, my heirs, representatives, executors, administrators, or any other person acting on my behalf or on behalf of my estate, have or may have by reasons of this authorization.
By typing my name and today’s date below, I acknowledge that I have read and fully understand the Media Release.
Confidentiality Agreement
Confidentiality is the preservation of privileged information concerning the clients and staff of this agency which may be disclosed in a professional working relationship. A part of what you learn is necessary to provide services to the agency or clients; other information is shared within the development of a helping, trusting, and professional relationship. Therefore, most information gained about individuals through an assignment is either confidential in terms of the law, and disclosure could make you personally legally liable, or could damage the agency’s relationship with the clients and make it difficult to continue working with them.
All records dealing with the clients and/or staff must be treated as confidential. Financial information, records from personnel files, and all other relevant information is considered confidential. Sharing data, copies of client or staff records, or information from such records may make you subject to the laws and penalties of breaching confidentiality. Giving information, data, or copies of client or employee records to unauthorized persons, or entities, is not acting within the scope of duty and the agency could refuse to support you in the event of legal action. Violation of the Oregon Revised Statutes regarding confidentiality of records is punishable upon conviction by a fine of not more than $1,000 or by imprisonment in the county jail for not more than 60 days, or both. Furthermore, such action on your part may result in disciplinary action, up to and including termination of employment.
By typing my name and today’s date below, I acknowledge that I have read and fully understand the Confidentiality Agreement.
Agreement to Terms of Volunteering
Checking the boxes below signifies acknowledgement:
By providing my electronic signature and today’s date below, I confirm that I am 18 years of age or older, and I acknowledge that I am formally submitting this application. I confirm that all information I have provided is accurate to the best of my knowledge, and I understand that my electronic signature has the same legal effect as a handwritten signature.
