GBJCL Volunteer Personal Consent Form

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Membership ID

Contact ID

Consent

First Name

Last Name

am agreeing to participate as a tutor for the Greater Boston Jewish Coalition for Literacy (GBJCL) which is program of the Jewish Community Relations Council of Greater Boston (JCRC). I understand that JCRC will assist in assigning me to a synagogue team comprised of individuals who will tutor in a designated public school. I understand that I will be required to pass a background check, including but not limited to a Criminal Offender Record Information (CORI) in order to participate in the GBJCL program.

I understand that the synagogue team to which I am assigned will assign me to a public school to tutor. I understand that the public school to which I am assigned will assign me a youth to tutor. I understand that I will be provided with instructions and direction related to tutoring by the public school to which I am assigned and that I shall follow said instructions and directions. I understand that JCRC does not control or direct the public school to which I am assigned and does not control or direct the rules and regulations established by the school as it relates to the GBJCL tutoring program. I understand that JCRC does not control or direct the synagogues as it relates to the GBJCL program but coordinates the program. I understand that to participate in the GBJCL program I must follow any and all directions of the GBJCL program as established by the synagogue team to which I am assigned and the school district to which I am assigned as a tutor. I understand my participation in the GBJCL program is at the discretion of the synagogue team to which I am assigned and the school district at which I am assigned to tutor.

I hereby release and hold harmless JCRC from any and all claims, demands, actions and causes of action of every name and nature which I might have against JCRC as a result of my participation in the GBJCL Program.

(To sign, please insert your name below)

Signed and sealed this Date (day of the month)

of (name of the month)

in the year of 2024

Your Information

Email Address

Please select your team from the list below

By submitting this application you agree to the following:

Photo/Image Release
You acknowledge that the Jewish Community Relations Council of Greater Boston and its related programs ("JCRC") to use your likeness in a photograph in any and all of its publications, including any electronic media, without payment or any other consideration. You acknowledge that these materials are the property of JCRC and will not be returned. You acknowledge that the JCRC has the right to edit, alter, copy, exhibit, publish or distribute any photos of you or your likeness for purposes of publicizing JCRC’s programs or for any other lawful purpose. In addition, you waive the right to inspect or approve any finished product, including written or electronic copy, wherein your likeness appears. Additionally, you acknowledge that you waive any right to royalties or other compensation arising or related to the use of your likeness. You will hold harmless and release and forever discharge JCRC from all claims, demands, and causes of action which you, your heirs, representatives, executors, administrators, or any other persons acting on your behalf or on behalf of your estate have or may have by reason of this authorization.

Background Checks
You understand that the municipality or school system where you plan to volunteer may conduct a background check (CORI) as is standard practice in the Commonwealth of Massachusetts. You understand that all school systems conduct their checks independently from JCRC and it is your responsibility to confirm annually that your security clearance is up-to-date.

Age Requirement
You acknowledge that you are at least twenty-one (21) years of age or will have turned twenty-one by the time your background check is completed by the school/district in which you are volunteering.

If you have any questions about the above, please contact Rebecca Shimshak at rshimshak@jcrcboston.org or (617) 457-8678.

You allow JCRC to contact you about GBJCL and its other program offerings.

If unchecked, staff will only contact you regarding this GBJCL Volunteering opportunity and future opportunities.

By clicking submit, you acknowledge that you have read the releases above and that you fully understand the contents, meaning, and impact of these statements.

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