Heart House Volunteer Application

Introduction

Welcome! At Heart House, we believe every child deserves the opportunity to learn and grow in a safe environment where self-expression, creativity, and diversity are celebrated. For more than twenty years, Heart House has been that safe space for numerous children in the Vickery Meadow neighborhood of Dallas. Our program provides Heart House students with academic help and social-emotional support.

As a volunteer, you will be providing classroom support to students of Heart House. We have 3 Programs.

School year, Out-Of School program runs Monday - Friday from 3:30 PM - 6:00 PM.
Summer program runs from Monday - Friday from 10:00 AM - 3:00 PM.
Reading Homeroom program! As a tutor, you'll work one-on-one with a newcomer student at Lee A McShan Elementary School, guiding them through the basics of phonics, writing, and reading comprehension with a side of social-emotional learning. These young students, who have been in the U.S. for less than a year, are refugee and immigrant English Language Learners eager to thrive in their new environment. You don’t need prior teaching experience—our team provides all the curriculum, supplies, and hands-on coaching you need to succeed. Just one hour of your time can help build a child’s confidence, foster their love for learning, and open doors to a brighter future. Join us in achieving our goal of literacy and justice for all!

One-Hour Tutor Application: https://forms.gle/PubQSo1CzYtHBZ7s9

As part of your application, you will be guided through the following sections:

Volunteer Application
Volunteer Code of Ethics
Consent for Criminal Background Check: Authorization/Wavier/Indemnity (non-minors only)
Criminal History Records Check Statement (non-minors only)
Parental Consent & Liability Release for Minor (minors only)

Before submitting your application, please ensure that all information is current and accurate. You must complete and e-sign this form to be considered for volunteering.

Acknowledge the below statement and click "Next Page" to begin your volunteer application!

I understand I must complete the application, orientation, and Dallas ISD Voly background check (and send the cleared confirmation email to Heart House) to be considered for volunteering at Heart House. I understand that my duties may consist of:

H3 (after school and/or summer): Supporting the classroom teacher(s), providing additional student supervision, working in student small groups, being a positive mentor to children, assisting with lessons, crafts, projects, homework, recess, snack, cleaning, and other activities as determined by Heart House staff. Reading Homeroom (daytime tutoring): Meeting a minimum of one hour a week with my assigned student in my time slot and using the Heart House curriculum and elements of social emotional learning to support my student’s academic gains and personal wellbeing, as well as keeping tutor records of each session and creating a positive, welcoming, and encouraging environment for the child to learn.

Skills & Interests

Languages Spoken (select all that apply):

Preferred Age Groups (select all that apply):

Availability

Most volunteer opportunities occur during the following times:

Reading Tutor: Monday-Thursday One hour Slot between 08:00 AM to 02:00 PM

School Year: Monday - Friday from 3:00 PM to 6:00 PM

Summer: Monday - Friday from 10:00 AM to 3:00 PM

***Saturday opportunities arise as needed.

Day Reading Tutor Availability:

After-School Availability:

Summer Availability:

Desired Start Date:

Please clarify your availability:

Emergency Contact

Emergency Contact Full Name:

Relationship to Volunteer:

Phone Number:

Heart House Volunteer Code of Ethics

1. Smoking or use of tobacco in the presence of children is prohibited.

2. Using, possessing, or being under the influence of alcohol/illegal drugs will not be tolerated.

3. Volunteers shall not abuse children in any manner, including, but not limited to:

Physical Abuse: striking, grabbing, spanking, shaking, or slapping
Verbal Abuse: humiliation, degradation, cursing, or threats
Sexual Abuse: inappropriate touching, exposure, or conduct which creates a sexually hostile environment

4. Volunteers must treat children of all races, gender, religious backgrounds, and cultures with equal respect and consideration.

5. Volunteers must use positive techniques of guidance, including positive reinforcement and encouragement, rather than criticism.

6. Volunteers shall abstain from use of humiliating or frightening discipline techniques.
Volunteers shall not use inappropriate or offensive language.

7. Volunteers will serve as a positive role model for Heart House youth by maintaining an attitude of respect, patience, integrity, courtesy, tact, and maturity.

8. Volunteers will not babysit or invite children to their homes or social events without written consent from the Heart House Executive Director and the children's parents/guardians.

9. Volunteers will adhere to dress code policies while working with children, including:

Wearing modest clothing, including: shorts and skirts of modest length and no spaghetti strap tops, tube tops, or low cut tops
Covering tattoos and piercings when reasonably possible

I understand that as a volunteer for Heart House, I will be subject to a criminal background check. I have read the Volunteer Code of Ethics and fully agree to comply with them. I understand that Heart House Board may relieve me of my duties if it concludes in the exercise of its' sole discretion that I have violated these rules or other Heart House policies and procedures.

Printed Name:

Date:

After submitting your application, our team will send you the link to begin your background check. Individuals under 18 are exempt.

Art Work, Photos, and Writings Release

I hereby authorize that photographs or recordings of myself and writing or artwork collected from me may be taken or used in connection with my participation in learning center programs and activities and give permission for such artwork, photographs, and writings to be published and/or sold in marketing or fundraising activities. This may include photos and other representations used in printed materials, videos, online newsletter or websites.

Printed Name:

Date:

Parental Consent & Liability Release for Minor

Voluntary Participation:

I acknowledge that my child,

, is at least sixteen (16) years of age and has voluntarily applied to assist Heart House Dallas in providing homework and tutoring assistance to the children that Heart House Dallas serves. I understand that as a volunteer, my child will not be paid for his/her services and that he/she will not be eligible for any Worker's Compensation benefits.

Release:
In consideration of the opportunity afforded my child to assist Heart House Dallas, I hereby agree that I, my child, my assignees, heirs, guardians and legal representatives will not make a claim against Heart House Dallas or any of its affiliated organizations, either of their offices of directors collectively or individually or the supplier of any materials or equipment that is used by Heart House Dallas or any of the volunteer workers, for the injury or death of my child or damage to his/her property, however caused, arising from his/her participation in volunteering at Heart House Dallas. Without limiting the generality of the foregoing, I hereby waive and release any rights, actions, or causes of action resulting from personal injury or death to my child or damage to his/her property sustained in connection with volunteering with Heart House Dallas. I further consent to the unrestricted use by Heart House Dallas and/or persons, authorized by them of any photographs, recordings, interview, videotapes, motion pictures, or similar visual recording of my child.

Yes

Signed this

day of

in Dallas, Texas.

Emergency Parent/Guardian Contact

Parent/Guardian Full Name:

Street Address:

City:

State

Zip Code:

Phone Number:

Email:

Asian	Black African
Black American	Hispanic or Latino
White	Other
Native American

Some High School	High School
Some College	Associate Degree
Bachelor's Degree (B.S. or B.A.)	Master's Degree (M.S. or M.A.)
Doctorate (Ph.D. or M.D.)	Other