_____I understand that the references, employers, and volunteer organizations I have provided will be contacted and
that the Taney County TimeBank will do a background check on applicants.
_____I consent to the release of all relevant information concerning my ability and fitness to work as a Taney
County TimeBank member.
_____ I understand that my contact information and selected information from my enrollment form will be published in
the Taney County Time Bank member/services directories (on our web site) and shared with other Taney County
Time Bank members.
_____ Members of the TimeBank offer neighborly services or skills to one another as volunteers. The TimeBank is a
coordinating agency only; it is not responsible for the services performed by TimeBank members. Members
provide services to the best of their ability and do not guarantee their work. Prior to receiving a service, it is my
responsibility to ascertain the competency of the server to deliver that service to my satisfaction.
_____ I understand that expenses for any materials used will be the responsibility of the recipient, and expenses will
be agreed upon before the service is delivered.
_____ I understand that the Taney County TimeBank cannot be held responsible for any injury to persons or
damage to property experienced while involved with the program. The applicant hereby agrees to hold the
Taney County TimeBank, as well as its employees and/or agents harmless from any and all claims or
liabilities for any work performed hereunder by a TimeBank volunteer.
_____ I understand that Taney County Time Bank does not assess anyone’s skills and I agree that if requesting a service requiring a
licensed professional I must only accept service from a licensed professional. Further, I agree that if I am providing a service
that requires a professional license, I have a valid current license.
_____ I agree to take responsibility for any accident or injuries that I might suffer while on property owned or rented by
any TimeBank member and waive any claim against that member.
_____I agree that if I use my personal vehicle in rendering volunteer service through the Taney County TimeBank, I
will, in accordance with Missouri law, arrange to keep in effect adequate and legal automobile liability
insurance covering bodily injury and property damage.
_____ I agree that I will accept no monetary payment for services, or no monetary reimbursement for driving with the
Transportation Program as a Timebank driver (other than money for gas of personal vehicle, pre-arranged).
_____ I understand and agree that I must hold all member health care and personal information in confidence and that
intentional or involuntary violation of that confidentiality may result in disciplinary action which could include
dismissal from the program.
_____ I have completed Taney County Time Bank orientation. I have read and understand the information in the Taney County Time
Bank member position description and the information as stated in the Taney County Time Bank Handbook; I agree to abide
by its contents as well as other forms (documents) I am required to complete before starting service and any other forms
required by TCTB. I understand that the Taney County Time Bank Handbook is subject to periodic revisions.
_____I understand that failure to abide by the Taney County Time Bank member position description, the contents of the Taney
County Time Bank Handbook and other required forms would be cause for my dismissal from participation in Taney County
____ I have read this document and the handbook and understand the contents. I certify that the information given on this form and
the application is accurate to the best of my knowledge.