Volunteer Application and Confidentiality Agreement Here’s the volunteer form and Confidentiality Agreement Name* First Last Home Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code United StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Primary Phone*Secondary PhoneEmail* Deceased Child(ren) or Grandchild(ren) name(s)*Deceased Child(ren) or Grandchild(ren) birthdate(s)*Deceased Child(ren) or Grandchild(ren) date(s) of death*Please tell us about the circumstances surrounding your child(ren) death*How are you CURRENTLY coping with your grief* Yoga/Meditation Faith/Prayer Counseling/Support Group Family/Friend/Communtiy support Medication - ****see below Other - ***see below Please check all that applyName(s) of CURRENT medications - if checked aboveOther current ways of coping if checked aboveWhich volunteer roles are you interested in? Check as many as you like.* HOPE Mentoring of bereaved parents (1-to-1 mentoring) Group Facilitation Grandparent Mentoring Forum Moderation Administration Event Coordination PR/Marketing/Communications Fundraising Forum Chat Moderator HOPE Mentoring of Grandparents (role is for grandparents who are bereaved) Do you have any past experience in volunteering and if yes, please tell us about itDo you have any special interests or skills that you think would like to share with us, or is there anything else you would like us to know about you, your family, or your child?Do you volunteer for, or are you involved in any other loss groups? If so, why do you want to volunteer with the MISS Foundation?*Have you been referred to us by a current MISS Volunteer? (If yes, please tell us who.)*NoYesReferring MISS Volunteer (if any)Please provide 3 references we can connect with: Please include each reference's name, address, e-mail, and the nature of your relationship with them:Reference 1*Reference 2*Reference 3*By checking the box below, I affirm my understanding that the following is a list of MissFoundation's "15 Guiding Principles", the "Terms of Volunteering" and a binding Confidentiality Agreement, and that I will read all in its entirety.* I affirm 15 Guiding Principles of MISS Foundation Volunteerism For volunteers of the MISS Foundation when working with our bereaved families (scroll the section below to view and read all items) We believe that grief resulting from the death of a child presents one of the most traumatic and painful circumstances for individuals and families. We believe that our community known as the MISS Foundation, helps create a safe environment in which individuals and families are better able to be with, surrender to, and eventually take compassionate action in the grief journey; We believe it is our sacred duty as leaders to protect members within our community and ensure to the best of our abilities that support groups and other MISS Foundation related functions remain a safe space for all bereaved parents, grandparents, siblings, and others. Part of the community process is building deeply intimate relationships based on civic love and compassion with our families. We accept others as they are, we are always kind first even when someone is unkind to us; we strive to be long-suffering in response to stress; we practice our own deepening of self-awareness and compassion; we do our best not judge others; if we cannot help someone, we do our best to help them find such support; we do our best not react in fury or frustration, rather we do our best respond gently to others; we take care of ourselves and one another; if we do not like or agree with something someone else says or does, we try to remember that we need not respond in anger and sometimes need not respond at all; we seek the council of trusted others without compromising confidentiality; we do not speak disparagingly or gossip about others in our community and we model appropriate, professional group behavior for other members; we extend a loving hand and heart in the best way we can; and, in borrowing from AA’s very successful model we put our principles before our personalities. As an organization and sometimes as chapters, we may seek opportunities to bridge the gap between us and the non-bereaved communities in which we reside. This may mean planning community-based activities such as support groups, family remembrance ceremonies or picnics, and other events, which bring us together. We trust in the inherent wisdom of our grief, and we respect the grief of others. We do our best to meet their needs, guiding them on their terms not ours. We respect each person’s unique grieving style and engage in mindful, nonjudgmental relationships which do not pathologize their experiences and expressions of grief. We do not diagnose or label one another with mental disorders. We do not diminish the value of another parent’s child based on their cause, age, or circumstances of death. We believe in individual and family strengths, and we do our best to use those to benefit our clients and their family systems. We pledge to remember and honor the lives of the children who died too soon and stand with our families as they mourn. We care deeply for our community and engage in activities which reflect such human caring. We believe that, as volunteers, self-care, self-awareness, and self-compassion as well as ongoing education are crucial to our community’s well-being. Thus, we commit to strive toward good self-care and ongoing educational opportunities when available to us. We strive to offer uniquely individualized care that creates healing environments for our clients. We are not constricted by rigid guidelines or rules which do not, ultimately, result in best care practices for our families. If we have a concern or complaint about another volunteer or leader in the group, we first approach that person with kindness; if we cannot resolve our issue, we will work together to seek council from trusted leaders within the organization; we will ask ourselves before we speak: Is this kind? Is this necessary? Does this improve upon the silence? Is it being said with love or with anger? And we will not speak of the experience with others in such a way that it promotes gossip or in any way undermines the value and worth of the other person. We recognize the efforts of many other volunteers, just like us, and their tireless labor of love and grief. Thus, we invite you to remember to express gratitude to others within the organization for this beautiful work which we are all privileged to do and to exercise patience at all times. We are doing the best we can with the resources we have. Imagine, for a moment, if we heard that the person we are aggravated with- or the person we dislike- or the person who frustrates us- died today. Imagine how it would feel to leave the relationship in this way. This feeling is an invitation to mindfully adjust the ways in which we choose to think about, experience, and treat others. We are here to behave in ways which honor all our children. When we fail to meet the guidelines of the 15 principles, and we will fail because we are human, we accept responsibility for our actions and we offer a sincere apology to those we have hurt; When someone apologizes to us for hurting us, we accept their apology with grace; We are part of an unwilling community of brothers and sisters here to embrace and manifest their collective legacy. Guided by the ethics of human compassion, we serve, we care, we nurture, we exude kindness. Above all things, be love. TERMS OF VOLUNTEERING I understand that the role for which I am volunteering requires the following: (scroll the section below to view and read all items) Volunteer training, which I will complete within 1 month of acceptance. If I have not completed training within the given timeframe, I understand I will be removed from “active volunteer status.” Return to active status will be at the discretion of the volunteer coordinator. Additional ongoing “continuing education” is offered. We request that all volunteers make an effort to attend these additional trainings when possible. That I will respond to any contact from my volunteer coordinator within 72 hours. If I do not respond, I understand I will be removed from “active volunteer status.” Return to active status will be at the discretion of the volunteer coordinator. I understand (Facilitators) that I am expected to communicate with the international home office of the MISS Foundation within a reasonable period of time should they initiate contact with me. If I do not, I understand that my support group's status may be revoked and my information may be removed from the website. If I am unable to fulfill any or all of my role for any length of time, I will notify my volunteer coordinator. Volunteers who request to be moved to “inactive status” can return as active volunteers whenever ready. That I understand that confidentiality must be maintained at all times. Confidential information should not be shared via regular email, Facebook, or with anyone outside of the MISS foundation. That I will be given a MISS Foundation email address. To maintain help confidentiality, contact with members and other volunteers should be made through that MISS Foundation email. That I understand personal boundaries are important and I am willing and able to set them for myself and respect those set by members and other volunteers. That I understand that our members and volunteers are all bereaved parents, grandparents, or family members, and I will be sensitive to the needs of those around me. Any concerns I have can and should be discussed with my volunteer coordinator at any time. VOLUNTEER CONFIDENTIALITY AGREEMENT WHEREAS, the MISS Foundation is a nonprofit corporation chartered under the law of the State of Arizona and qualified under Section 501 (3)(c) of the Internal Revenue Code; and WHEREAS, the mission of MISS is not limited to the borders of the State of Arizona; and WHEREAS, the Volunteer is desirous of advancing the MISS mission in the state of Arizona and/or a state other than Arizona; and WHEREAS, MISS is governed by certain legal and moral restrictions on its nonprofit activities, and MISS owns certain property, both physical and intellectual, some of which is protected by copyright and some of which is not; NOW, THEREFORE, the parties hereto enter into the following agreement; (scroll the section below to view and read all items) That the Volunteer is provided a MISS Foundation Training Program. That the MISS Foundation allows said MISS Volunteer to use the MISS name and logo for any and all MISS business, but only for MISS business. That the Volunteer shall provide support services to the best of its ability to the target population of its selected service area. MISS agrees to provide support to the Volunteer in the form of technical assistance and training in providing MISS services. At the discretion of MISS, such assistance may or may not include financial contribution. That the Volunteer recognizes that the value of the MISS services and the MISS name are dependent upon the quality of the services provided and that Volunteer agrees to do nothing that may tend to detract from the value or reputation of MISS. That the Volunteer shall not speak with members of the press, submit a letter to the editor, or otherwise participate in any media contact regarding MISS without the prior express written approval of the Chief Executive Officer of MISS. That the Volunteer shall not conduct fundraising activities on behalf of MISS without the prior express written approval of the National MISS Foundation. If MISS National provides Volunteer with prior approval, the Volunteer shall retain all records of all fundraising activities including all contact information of donors, dates and amount of donations and, unless prior arrangements have been made, immediately provide all funds to MISS Foundation, P.O. Box 9195 Austin, TX 78766 or another address as may be specified by MISS National. If prior arrangements are made for the receipt of the aforementioned documents, send to the National MISS Foundation with detailed descriptions of how the funds were used. Failure to do so may result in litigation against the MISS Foundation by the Internal Revenue Service. If any litigation occurs due to the Volunteer’s action, conduct or negligence, Volunteer shall indemnify and hold harmless the MISS Foundation for any damages, taxes, penalties and interest associated with such action. That, unless previous arrangements have been made, any money received by the Volunteer specifically for support services shall be accounted for and immediately delivered to MISS Foundation, P.O. Box 9195, Austin TX 78766 or another address as may be specified by MISS. Additional financial terms between MISS and the Volunteer may be arranged by separate agreement. At any time, MISS may request the Volunteer to provide an accounting of any and all funds and in-kind donations collected or spent by the Volunteer relating to MISS activities. Said accounting shall be audited and conform to generally accepted accounting principles. The nature of the services to be performed by Volunteer for MISS may require MISS to disclose confidential and proprietary information to the Volunteer. “Confidential Information”, for purposes of this agreement, includes any information of any kind, nature, or description concerning any matters affecting or relating to Volunteer’s services for MISS, including but not limited to MISS Foundation’s curricula, business operations, processes, staff, clients, client families, volunteers, donors, suppliers, products, services, business plans, methods of operation, manner of service delivery, fund raising information and other financial information, as well as any and all MISS Foundation intellectual property. The Volunteer recognizes that MISS Foundation Confidential Information is proprietary and in the sole property of MISS. The Volunteer agrees to keep such Confidential Information in the strictest of confidence and shall not disclose any Confidential Information until and unless Volunteer receives the prior express written consent of MISS to do otherwise. Confidential Information shall only be used for the purposes of performing services as a Volunteer to the MISS Foundation. Nothing in this paragraph shall be construed to prevent Volunteer from providing services as described in paragraph 4, or to otherwise advance the MISS mission. Volunteer will, upon the request of or termination of its relationship with MISS, deliver to MISS any paper or electronic drawings, notes, documents, equipment and/or materials received from MISS or originating from the activities for MISS, including, but not limited to Confidential Information. This includes all client/family information, photographs and correspondence. At no time is the Volunteer eligible to personally retain any funds or in-kind donations secured while in service to the MISS Foundation. MISS retains exclusive rights to all creative work, including business plans, curriculum or other creative work designed and created by or on behalf of MISS by Volunteer, and/or received by Volunteer, while performing services for MISS. MISS reserves the right to take any action, up to and including termination of Volunteer for violations of this agreement. Additionally, if Volunteer violates any of the terms of this agreement, MISS may enforce this agreement by means of an injunction, restraining order, money damages and any other available legal remedy. Volunteer agrees to pay all attorney’s fees and costs incurred by MISS in pursuing enforcement of this agreement. This agreement shall be construed in accordance with the laws of the State of Arizona, and the jurisdiction and venue for any litigation involving this agreement shall be in any court of the State of Arizona or a United States Federal District Court located within Arizona. Any waiver by MISS with respect to any breach or violation of this agreement or of any provision hereof by Volunteer shall not be deemed as or operate as a waiver of any subsequent breach or violation. This agreement shall not be modified, amended, or supplemented except in writing signed and dated by both Volunteer and MISS. The provisions of this agreement are severable and if any one or more of the provisions may be determined to be invalid or unenforceable, such provision (or portion thereof) shall be amended so as to be enforceable. The invalidity or unenforceability of any particular provision of this agreement shall not affect the other provisions and this agreement shall be construed in all respects as if any invalid or unenforceable provisions were omitted. By checking the box and providing my digital signature below, I affirm that I have read in its entirety, and agree to abide by, the above "15 Guiding Principles", the "Terms of Volunteering" and the Confidentiality Agreement* I so affirm The MISS Volunteer application is a step by step process. The timeline varies, but you will receive follow up emails along the way. Please respond to them within the timeframe given. Applying for volunteer status is not a guarantee of acceptance. Thank you.* I agree My Digital Signature*(Please type your name above.)To assure confidential and secure submission of your application, please enter the Captcha text below, and then click "Submit" .