Vivalon Volunteer Application

Please fill out this volunteer application if you are interested in volunteering, and we will contact you.

Contact Information

Emergency Contact

Additional Information

How did you hear about us?

Past Volunteer Information


Volunteer Opportunities (please pick your top 3 choices)

Driver Opportunity Information

  • Meals on Wheels / Nourish Driver
    • Deliver meals to homebound clients on Monday, Wednesday, or Friday 9:00am-12:00pm or 1:00-4:00pm, One 3 hour shift per week, Little contact.
  • Carepool (People)
    • Drive people to appointments/errands using your own vehicle, Either flexible hours or one day a week commitment, Contact.
  • CarePool (Deliver)
    • Deliver groceries/medication in your own vehicle, Either flexible hours or one day a week commitment, Little contact.

Complete this section if applying for a driver role.

Photo Release

From time to time, our Marketing department may take photos and videos to help us promote Vivalon and our various activities. Examples of how these photos and videos may be used include, but are not limited to: print ads, digital ads, newsletters, emails, website pages, letters, brochures, pamphlets, reports, presentations, video appeals.

I consent to the unrestricted use, by Vivalon (and those acting with its permission and authority), of any and all photographs/videos taken, in whole or in part, unlimited use, for all purposes, in any form or medium, including, without limitation, its use through or on any electronic media, including the Internet.

I waive any right to inspect or approve the finished product or products or the advertising copy or printed matter that may be used with the finished photographs/videos.

Further, I relinquish all rights, titles and interests I may have in the finished photographs/videos and reproduction to any responsible business firm or publication. It is understood that Vivalon retains copyright of images at all times under the expressed understanding and agreement that Vivalon shall have exclusive reproduction rights to the images/videos.

I hereby release Vivalon from any and all claims in connection with the photographs/videos, including any and all claims of libel.

Physical Activity Release of Liability


1.) I am acting at Vivalon's direction and within the scope of my duties as a volunteer for Vivalon;

2.) The accident takes place during the policy period;

3.) The expenses that are incurred are reported within one year of the date of the accident. Payments will be made regardless of fault (not to exceed the applicable limit of insurance) and include reasonable expenses for:

- First aid administered at the time of an accident;

- Necessary medical, surgical, X-ray and dental services, including prosthetic devices; and

- Necessary ambulance, hospital and professional nursing and funeral services.

Volunteer Nondisclosure and Confidentiality Agreement

I acknowledge that during the course of my volunteer role with Vivalon I will have access to certain information not generally known to the public.

I understand that this information is Confidential Information and agree that it is not to be shared at any time. I understand the need to safeguard, in any format including, but not limited to, database records, email, any other electronic format, hard copy, voicemail or conversation.

I understand that participant records are protected under confidentiality regulations and cannot be disclosed without written consent of the participant, as stated in HIPAA.

1. All Confidential Information provided to or generated by me, both hard-copy and electronic, is highly confidential. It is not to be discussed with anyone not conducting Vivalon business.

2. I agree to protect all Confidential Information when in use, storing it properly when not in use, and discussing it only with those who have a legitimate business need to know.

3. I agree to treat Confidential Information with care during my volunteer role with Vivalon.

4. I will not give data to persons not authorized to access it. I understand that Vivalon expressly forbids the disclosure of private data or the distribution of such data in any medium, except as required by my volunteer duties and responsibilities.

5. I understand that if I am found compromising information that I may be released in my volunteer role with the organization.

Motor Vehicle Record Release

If I am applying to volunteer, which will involve driving my own vehicle or a company vehicle on behalf of Vivalon, I hereby authorize Vivalon’s insurance company and/or Heffernan Insurance Brokers to be in possession of my driver’s license number, obtain the necessary motor vehicle records and authorize them to send a copy of my Motor Vehicle Record to Vivalon.

Hands Holding Heart icon
For more information
about volunteering at Vivalon, please contact, [email protected] or 415-456-9067.
Scroll to Top