Confidentiality Policy for Boysville Volunteers

Volunteers will ensure confidentiality and privacy in regard to the history, records and discussion about the people we serve. Volunteers will not discuss with or release any information regarding the children at Boysville to anyone outside of the organization, including but not limited to, Child Protective Services, case workers, family members, police, social workers, teachers and doctors. This includes, but it not limited to, the name, physical description, family history, story of abuse, or medical problems of any child at Boysville. This also includes no photographs may be taken of the children living at Boysville. A majority of the children we serve are in under the legal guardianship of the State of Texas or privately placed by a parent or family member. Some of these children will return home to their parents or to relatives. These children are at Boysville while their case is being investigated; they are not waiting to be adopted. The very fact a child is cared for at Boysville must be kept confidential. This means employees, consultants, volunteers, interns, etc. shall not disclose any information about a person, including the fact that the person is at Boysville, to anyone outside the organization unless authorized by the President/CEO or other authorized person.

___________________________ Printed Name

___________________________
Signature

__________
Date

Abuse/Neglect Responsibility Statement

As a volunteer of Boysville, I am aware of my responsibility to report incidents, or suspected incidents of abuse and/or neglect of children to the Executive Director, or another administrator within 48 hours. In accordance with state law, Boysville reports information about abuse or neglect of children to the proper authorities. Volunteers and staff are also required to report abuse and neglect to the proper authorities. ___________________________ Printed Name

___________________________
Signature

__________________________
Date

Contractor Affidavit Regarding Civil and Criminal History

1. Have you ever been convicted of a felony or a misdemeanor? _____Yes _____No If yes, give details including date, place, nature of conviction and disposition. 2. Are you currently charged with (indictment or official criminal complaints by county or district court) a felony or misdemeanor, including deferred adjudication? __Yes ___No If yes, give details, including the type of charge. 3. Have you ever been or are you currently being investigated for allegedly abusing, neglecting, or exploiting children, the elderly, or the disabled? ____Yes ____No If yes give details, including the county in which the investigation occurred, your social security number, your date of birth, and any other names you may have used this time frame. I hereby declare the information provided on this statement is true and correct.

___________________________
Printed Name

___________________________
Signature

_______________________
Date

VOLUNTEER FORM FOR MEDIA RECORDING I, the undersigned, do hereby grant or deny permission to Boysville, Inc. the use of my image as marked by my selection(s) below. Such use includes the display, distribution, publication, transmission, or otherwise use of photographs, images, and/or videos taken of myself for use in materials that include, but may not be limited to, printed materials such as brochures and newsletters, videos, slide presentations, digital images such as those on the Boysville, Inc. web site and Boysvilles social media site, such as Facebook, Twitter, LinkedIn, etc. Deny permission to use my image at all. Grant Permission to use my image in the following ways (mark all that apply): Limited usage: My image may be used within Boysville, Inc. setting only (not in the larger community). Limited usage: My image may be used on any printed, digital, or video material or social media sites with no name listed Limited usage: My image may be used on any printed material only with no name listed Unrestricted usage: I give unrestricted permission for my image to be used in print, video, digital media and social media. I agree that these images may be used by Boysville, Inc. for a variety of purposes and that these images may be used without further notifying me. I do understand that my last name may or may not be used in conjunction with any video or digital images.

Volunteer Printed Name: ________________________________ Volunteer Signature: ___________________________________ Date: ____________________

VOLUNTEER DRESS CODE

Clothing Polo/golf shirts Tank top/halter top Sleeveless dress/blouse Clean, wrinkle free denim jeans Slogan t-shirts promoting drinking, smoking, sexual misconduct, or other subjects not appropriate for children Logo only t-shirts (no inappropriate slogans promoting drinking, smoking, sexual misconduct, etc.) Sweat shirts (no inappropriate slogans promoting drinking, smoking, sexual misconduct, etc) Midriff tops Oversize t-shirt or sweater Hospital scrubs Capri pants Sweat pants Skirts/dresses (length or slit more than 2" above knee) Skirts/dresses (length or slit less than 2" above knee) Shorts (more than 2" above knee) Shorts (less than 2" above knee) Overalls Hats, ball caps (brim forward) Frayed or torn items Slip on/mule shoes/ clogs (without back strap) Open toed sandals Tennis shoes/Keds Flip flop/thong shoes Platform shoes Earrings (on ear lobe only) Dangling/ hoop earrings Visible body piercing (other than earrings on ear lobe) Fingernails (more than 1/2" past end of finger) Hair color/styles (spiked, Mohawk, unnatural hair color) Tattoos (visible) Appropriate x x x x x x x x x x x x x x x x x x x x x x x x x x X x X X Inappropriate

I have read and understand the volunteer dress code stated above. I understand that I will not be allowed to volunteer if I arrive at the activity in violation of dress code.

___________________________
Printed Name

___________________________
Signature

__________
Date