I understand and agree that in the performance of my duties as a volunteer of Canopy Children’s Solutions (Canopy) I must hold in strictest confidence any observations I may make or information I may hear regarding patients, patient families or staff.

I verify that the information provided by me on this application is true, correct and complete. I attest that I haven’t ever been charged with any crime and grant Canopy permission to verify this information in arriving at a decision.

I understand that any false or misleading statements or the omission of any information necessary to make this application complete will result in refection of my application or termination of my service.

Additionally, Canopy has my consent to photograph, video tape, or audio tape me performing my volunteer duties. I understand that these may be used toward the advancement of public education, the promotion of Canopy, and/or any other legitimate purpose.

I understand that upon my successful completion of the volunteer placement processes required at Canopy, I will become a volunteer. As a volunteer, I acknowledge that I will not receive compensation for services.