Certification & Release of Liability, Confidentiality, Photo/Interview release, PREA
Volunteer/Community Service Worker Certification & Release of Liability Statement
“I certify that the information contained in this application is true and complete to the best of my knowledge. I authorize investigation of all statements contained in the application and understand that any false or misleading statements or material omissions are cause for termination of my position. My position as a volunteer or community service worker is granted to me by The Salvation Army and will require a background check. My position as a volunteer or community service worker is granted to me by The Salvation Army and is a privilege not a right. My privilege may be revoked as deemed necessary by appropriate personnel. I recognize that The Salvation Army is a church and agree that I will do nothing to undermine its religious mission.”
This Release is made between The Salvation Army and the above named applicant. The releasing party does hereby forever indemnify, defend and hold harmless The Salvation Army and all of its officers, agents and employees, acting officially or otherwise, from any and all claims, demands, losses, actions, liabilities, litigation, causes of action, damages, costs and expenses of any kind and character (including reasonable attorneys fees) for, on account of or in connection with, any personal injury, or damaged or loss of any kind or character to property suffered or occasioned by the Volunteer, whether or not caused by or resulting from the negligence of The Salvation Army or any of its officers, agents and employees, acting officially or otherwise, in connection with or with regard to completing the required task.
Statement of Confidentiality
I realize that in the course of my time in a Salvation Army facility, I may be exposed to clients or client’s names and other confidential data regarding agency clients. I understand that any and all client data is confidential under Florida Statute, Chapters 394.459 (9) and the Code of Federal Regulations, Part 2, Title 42. Violations of state and federal statues can carry both civil and criminal penalties.
I further understand that no names or information about Salvation Army clients can be discussed with non-Salvation Army employees.
My signature acknowledges my agreement to abide by all agency confidentiality regulations and applicable laws. My signature acknowledges that I agree to sign in with The Salvation Army front desk and received the appropriate name tag identification each time that I volunteer; I agree to wear the name tag at all times while in any Salvation Army facility. I also agree that I will notify the front desk upon my departure from the facility and will return the assigned nametag.
Photo/Interview release
I grant The Salvation Army permission to take or use my photograph (still, continuous film, videotape or other mediums) for publication or broadcast. I consent to be interviewed for the general purpose of publication of any statement by me.
I hereby irrevocably grant to The Salvation Army, its successors and assigns, its agents and those by whom it is commissioned, the absolute, unrestricted and unlimited license, right, permission, and consent to use and reuse, disseminate, copyright, print, reproduce, publish and republish, for any and all trade purposes or commercial or other advertising or public purposes, and in any and all advertising, publicity, display, publication or media, my name, signature and likeness, and any portraits, pictures, photographic prints or other representations of me, or in which I may appear, or any reproductions or sketches thereof or parts thereof, photographic or otherwise, with such additions, deletions, alterations or changes therein as you in your discretion may make, either separately or together with my name or a fictitious name, or the name of another person, with or without any statements or testimonials made by me, or authorized by me which you may, in your discretion, prepare for use in connection therewith. I warrant that I have not limited or restricted the use of my name or photograph to the use of any organization or person.
I release The Salvation Army, its agents and employees, from any liability for the use of my image, voice, writings, statements, or opinions by or attributed to me.
PRISON RAPE ELIMINATION ACT (PREA)
It is the policy of the Salvation Army Residential Re-Entry Center to provide a safe, humane, and appropriately secure environment, free from the threat of sexual misconduct for all inmates by maintaining a program of prevention, detection, response, investigation, and tracking. We shall maintain a zero tolerance policy for sexual misconduct in its institutions and in any facilities with which it contracts for the confinement of inmates. Sexual misconduct among inmates and by staff towards inmates is strictly prohibited. All allegations of sexual misconduct and/or sexual harassment shall be administratively and/or criminally investigated.
WHAT ACTS ARE INCLUDED IN PREA?
- Sexual Misconduct between Staff and Resident
- Sexual Misconduct between Residents
WHAT ACTS ARE INCLUDED IN PREA?
- Sexual Harassment—verbal or physical
- Sexual Assault
- Sexual Abuse
- Sexual Contact
- Conduct of a Sexual Nature
- Conversations or Correspondence of a Sexual or Romantic Nature
WHAT ARE MY RESPONSIBILITIES?
Due to the serious nature of sexual assaults, staff/volunteers/contractors are responsible to report any knowledge of a resident-on-resident or staff-on-resident sexual assault that occurs. You must do so immediately by reporting to the Program Manager or Corrections Director through telephone, written or in-person correspondence.
Program Manager Corrections Director
Darla Sallin Kate Geist
(239) 628-1487 (239) 332-0140
Darla.sallin@uss.salvationarmy.org Kate.geist@uss.salvationarmy.org
I have read and understand my responsibilities related to PREA. I also acknowledge that I am aware that The Salvation Army Residential Re-entry Center has a Zero Tolerance Policy for sexual misconduct and sexual harassment.
THE SALVATION ARMY STATEMENT OF VOLUNTEERS FOR WORK WITH CHILDREN:
This statement will be completed by all applicants for volunteer work for any position involving the supervision or custody of children (under 18 years of age) or for any position in which the applicant is in any way involved with children. The completion of the statement will help to assure The Salvation Army that it will provide a safe and secure environment to those children who participate in its programs and who use its facilities.
I do hereby represent to The Salvation Army, with the understanding that The Salvation Army will rely upon the information provided in considering my application for work with children, that the following statements are true:
1. I understand the essential duties of my position in connection with the working with children in the programs of The Salvation Army. I have reported to my supervisor any accommodation I need to perform these essential job duties.
2. I have never been accused of abuse or neglect of any child or of actual or attempted sexual molestation solicitation or trafficking of any child.
3. I have never been arrested as a result of a charge of child abuse or neglect, or of actual or attempted sexual molestation, solicitation, or trafficking of any child.
4. I have never been convicted of child abuse, neglect or a crime involving actual or attempted sexual molestation, solicitation, or trafficking of any child.
5. I have provided The Salvation Army with a full list of the organizations for which I have worked (in a paid or voluntary capacity) in positions involving children. I authorize such organizations to provide to The Salvation Army any information they may have regarding my character and fitness for work with children. I release all organizations and individuals from any liability that may result from their furnishing such information to The Salvation Army.
6. I acknowledge that The Salvation Army is a branch of the Christian Church and I agree that I will conduct myself in my work with children in a way that is consistent with the religious and charitable policies and principles of The Salvation Army.
7. Having provided the foregoing information and having affirmed the foregoing statements are true, I recognize that any false information or statements are punishable under applicable laws.