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2. 
3. City of Yachats

   501 Highway 101 N

   PO Box 345

   Yachats, OR 97498

4. Phone: 541-547-3565
   Fax: 541-547-3063

6. Thank you for your interest in volunteering for City of Yachats.

   As part of our ongoing efforts to strengthen our community and support those in need, we are seeking volunteers.  Signing up as a volunteer will strengthen the community list if an event should arise.

8. First Name*
9. Last Name*
11. Phone #*
12. Email*
16. Please select what types of crisis volunteer work that you can help with*

    1. Emergency Response and First Aid Assistance
    2. Shelter and Relief Station Support
    3. Food and Water Distribution
    4. Communication and Coordination
    5. Search and Rescue Assistance
    6. Mental Health Support
    7. Transportation Assistance
    8. Family Support
18. Please describe any additional type of crisis volunteer work you are interested in performing
22. Emergency Information

    Name and contact information for the person to reach in the event of an emergency.

24. Name*
25. Phone Number*

27. I understand and agree to the following:

    • I will keep all issues pertaining to city business confidential
    • I may be subject to background and motor vehicle record checks.
    • I will adhere by Oregon Occupational Safety and Health Division (OR-OSHA) safety standards and training I am provided.
    • I have read and understand the Volunteer Policy.
    
    I hereby certify that the facts set forth in this volunteer registration are true to the best of my knowledge. I agree that if the information given in my registration, resume, or any other materials, or during any interview, is found to be false in any way, it shall be considered sufficient cause for denial of volunteer status. 
    
    I understand that City of Yachats is not obligated to appoint me to a volunteer position and that nothing contained in the volunteer registration form is intended to create a contract between City of Yachats and me. In addition to the above items, I agree to comply with the policies, rules, regulations, and procedures of City of Yachats, which I understand may change at any time and I understand that my volunteer status can be terminated with or without cause or notice, at any time, at the option of either me or City of Yachats.
29. Signature*
30. Date*
    Date
32. Required for all Minors: Parent or Guardian's Authorization for Medical Care & Consent to Agreement

    I PARENT/GUARDIAN as parent or legal guardian, hereby grant permission for MINOR to do volunteer work for City of Yachats. In the event of an emergency, accident, or illness, I authorize City of Yachats and its employees to administer emergency medical care to my child and/or, if deemed necessary, to secure emergency medical services and incur expenses for which I will be responsible for payment. My signature in the following hereby represents that I have read, understand, and to this agreement. 

34. Parent/Guardian
35. Minor
37. Signature
38. Date
    Date
40. Version 2024-04-14
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42. 1. Receive an email copy of this form.
43. Email address

    This field is not part of the form submission.

44. Submit

* indicates a required field