Volunteer Enrollment Form

 

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  • Federal Diversity Reporting Requirements
    The following information is for statistical purposes only. Providing this information is voluntary.
  • INFORMATION FOR VOLUNTEER ACCIDENT INSURANCE

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  • As a volunteer of RSVP, you will be covered by accident and personal liability insurance plus a $2,500 death benefit while performing volunteer duties. This coverage is automatic and free of cost to you, so long as you are an active, enrolled member of RSVP.
  • By signing below, I acknowledge that I have read and understand the following statements:
    • I hereby state that I am 55 years of age or older and offer my services as a volunteer for the Pinellas Opportunity Council, Inc. Retired Senior Volunteer Program. I understand that I am not an employee of the RSVP project, the sponsor, Pinellas County, the volunteer station or the Federal Government and agree to serve without compensation.
    • I understand that in my capacity as an RSVP volunteer I may come into contact with confidential information. I agree to protect this information to the best of my ability and not to disclose it during or after my service as a volunteer has ended.
    • I understand that if I use my personal automobile in my volunteer service, I will arrange to keep in effect the automobile liability insurance equal to or greater to the minimum requirements of the state of Florida. I will also keep in effect a valid Florida Driver’s license.
  • Date Format: MM slash DD slash YYYY

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