By submmitting this application, I verify that the information provided is true, correct, and complete. I hereby give my consent to Gladden Community House to verify this information, including contacting references, and unconditionally release Gladden Community House from all liability, which might result. I understand that my acceptance as a Gladden Community House volunteer is on a conditional basis, and that Gladden Community House reserves the right to terminate the service of any volunteer whose conduct and performance in any way reflects negatively upon the agency.

(Optional – check if “yes”) I grant full permission to the sponsors, organizers, and affiliates to use my name, photographs or any other record of participation in this volunteer service for use in any broadcast, telecast, or any other written account of the service for publicity purposes, without compensation or remuneration.