Statement of Understanding and Signature:

By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a volunteer, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal.  Further, I authorize inquiries to be made concerning my suitability as a mentor. This will include a check for any past criminal record. I understand the information requested in this application will be used only for the purpose of determining my suitability as a mentor.

As a volunteer, I understand I am not an employee of the Mental Health Association (MHA) or the County of Orange and I am not covered by Worker’s Compensation or the County of Orange Memorandum of Understanding. The Mental Health Association of Orange County and the County of Orange and its officers, employees and agents shall not be held liable for any death, injury or property damage claims arising from volunteer work. If any claim should arise out of the foregoing, I shall defend, indemnify and save harmless the agencies named above.

I understand that at any time my volunteer agreement may be cancelled without reason and that if I use my own vehicle for any MHA or County business, I will maintain insurance as requested by law.

PLEASE BRING YOUR DRIVER’S LICENSE AND PROOF OF INSURANCE TO YOUR FIRST INTERVIEW