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City of Yachats Volunteer Agreement

  1. City Logo 172x172

  2. City of Yachats

    441 Highway 101 N
    PO Box 345
    Yachats, OR 97498

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

  4. Thank you for your interest in volunteering for City of Yachats. We look forward to partnerships with volunteers to enable us to effectively serve the citizens of our community. In order to ensure the safety of our volunteers and protect the interests of City of Yachats, we require potential volunteers to complete this questionnaire form and participate in a background check. Thank you for volunteering.

  5. Volunteer Activity

  6. "Any time” can be a stated date range.

  7. Please provide a short narrative about why you chose to apply for this particular committee or commission. You may attach a document below, if needed.

  8. References

    Please list two references that are not related to you and that have knowledge of your relevant experience for the type of volunteer activity you are interested in.

  9. Reference 1

  10. Reference 2

  11. Emergency Information

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

  12. 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.

  13. 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. 

  14. Version 2019-04-16

  15. Leave This Blank:

  16. This field is not part of the form submission.