Holiday Care Program: Sponsor

Thank you for your interest in sponsoring a family for There With Care this holiday season. Please submit your preferences below and contact us if you have any questions.

We value your privacy and respect your honesty. Volunteer applications are kept confidential, using the same standard of privacy as dictated by HIPAA.  NOTE: Please read the application and complete and sign the form at the bottom. Every sponsor and/or volunteer who is in contact with a There With Care family must submit a signed form. 

Section 1:  Volunteer Acknowledgement

I understand that the work I am performing for There With Care is being provided in a sponsor and/or volunteer capacity.  I understand that I will not receive any compensation or any other benefits in connection with my volunteer position. To the best of my knowledge, there is nothing that will prevent me from being able to perform the essential duties of this volunteer position, as explained to me by There With Care personnel.

In light of COVID-19, I will follow There With Care policies and procedures, as explained to me by There With Care staff, should I choose to make deliveries to any family as part of my participation in this year’s Holiday Program.

Section 2:  Photographic and/or Video Release

I hereby give my permission to be photographed and/or videotaped, and I understand that the resulting photographs may appear on the website and other marketing materials for There With Care.

For valuable consideration, receipt and sufficiency of which is hereby acknowledged, but without a fee, I hereby irrevocably grant There With Care and its licensees and assigns the right to use all or any part of the photographs and/or video. I agree that I shall have no right, title, or interest in or to the photographs or any version thereof, including without limitation claims based upon right of privacy or right of publicity, or for any fees or other considerations for such use.

This release shall be construed according to the laws of the State of Colorado, without regard to its choice of law provisions.

Section 3:  Confidentiality, Conflict of Interest and Ethics Statement

As a volunteer of There With Care, I have an obligation to the organization I serve, to the general public, and to myself to maintain the highest standards of ethical conduct.  I will not commit acts contrary to these standards nor will I condone the commission of such acts by others within the organization. I have a responsibility to:

Confidentiality

• Keep confidential information confidential unless legally obligated to do otherwise.
• Refrain from using or appearing to use confidential information, including protected health information acquired in the course of my service for unethical or illegal advantage either personally or through third parties.

Conflict Of Interest

Avoid direct or indirect, actual or apparent, conflicts of interest and advise all appropriate parties of any potential conflict, if:

• There With Care representative’s personal business provides goods or services to There With Care for consideration.
• A friend or relative of There With Care representative provides goods or services to There With Care for consideration.
• A vendor or business acquaintance with whom a There With Care representative has an outside business relationship provides goods or services to There With Care for consideration.

Refrain from engaging in any activity that would prejudice my ability or the ability of others to carry out duties ethically.

Refuse any gift, favor, or hospitality that would influence or would appear to influence my actions or the actions of others, for example:

• A There With Care representative receives a referral fee or preferential discount, gift, or other valuable consideration from a vendor, paid promoter, fund-raising event sponsor, or any other outside party, for referring There With Care business to such party.

Section 4:  Release of Liability

Participants hereby release and agree to indemnify and hold There With Care harmless for, from and against any and all liability, damages and claims (“claims”) of any kind, known and unknown, which may be connected with, result from, or arise out of care or services provided by There With Care including, but not limited to, claims involving economic loss, illness or medical condition, accidental injury or death, suffered by any of the participants.  Such services include without limitation the delivery of food, clothing, transportation, professional services, therapeutic support, home maintenance, and other product services.  Participants hereby acknowledge that they understand such services and products may entail risk of injury or harm to the participants and agree that this risk is fully assumed by the participants.

Participants agree that this Liability Release and Authorization fully and accurately expresses their understanding and has not been and shall not be modified except in writing signed by each of the Participants and There With Care.

I attest and agree to be bound by the foregoing standards. I have not been party to an unethical or conflicting action that has not been previously disclosed.  I also agree to report any potential future conflicts of interest or observed unethical activity of which I have become aware to the appropriate parties. I do not currently have pending against me any criminal proceedings, nor have I been placed under arrest for or been convicted of a criminal offense within the past year.

Section 5:  Legal Assurance

I agree to:

• Submit to a criminal background check.
• Report any present, past, or future allegations of criminal activities, criminal investigations, arrests, and/or convictions involving myself.
• Maintain integrity.
• Refrain from violating any criminal or civil law or regulation.
• Refrain from either actively or passively subverting the attainment of the There With Care’s legitimate and ethical objectives.
• Refrain from engaging in or supporting any activity that would discredit There With Care.
• Perform my duties in accordance with relevant laws, regulations, There With Care policies and standards.
• Represent the interests of all people served by this organization and not favor special interests inside or outside the organization.

I have not been party to an unethical or conflicting action that has not been previously disclosed.  I also agree to report any potential future conflicts of interest or observed unethical activity of which I have become aware to the appropriate parties. I do not currently have pending against me any criminal proceedings, nor have I been placed under arrest for or been convicted of a criminal offense within the past year.

I have completed and reviewed the entire Volunteer Application and attest that the information I have provided is true.  Additionally, I understand and that certain volunteer positions require the completion of a criminal background check, which will be updated every three years.

I agree to the term stated above pertaining to the Photographic and/or Video Release, Release of Liability, Confidentiality, Conflict of Interest and Ethics Statement and Legal Assurance and I acknowledge that I have received appropriate training and the materials listed above. Any questions I have were adequately addressed.

Thank you for your time and care for the families. The Holiday Care Program team will contact you soon.