Chapter Leadership Application

Step 1 of 5

This completed application along with social security number and three references (one pastor's and two professional) MUST be submitted to Special Touch National Office by December 1, 2022 for each Chapter Officer and/or Supervisory Volunteer to be approved for 2023.

Chapter Name *

Preferred Name *

First

Last

Physical Address of Home *

Address Line 1

Address Line 2

City

State

Zip Code

Mailing Address

My mailing address is different than above

Cell Phone *

Other Phone

Email *

Confirm Email

If you are receiving errors when submitting this form completely, use the Save and Resume Later link below to save your information. Then contact us by emailing ministry@specialtouch.org

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Special Touch Ministry Leadership Agreement

In line with our mission to ease and enrich the lives of people impacted by disability, it is the goal of Special Touch Ministry, Inc. to provide memorable and rewarding programs and services. Your participation is greatly appreciated. Our mutual agreement is subject to the Terms and Conditions listed below:

UNDERSTANDING I understand with my agreement I am not considered to be employed by Special Touch Ministry, Inc. and I am not eligible for compensation or payment of any kind. Furthermore, I acknowledge that Special Touch Ministry, Inc. does not offer any employee benefits to volunteers. I understand Special Touch Ministry, Inc. does not provide health insurance and I must maintain my own insurance during my time volunteering for Special Touch Ministry, Inc.

I understand in the event I use my personal motor vehicle, equipment, home, or any other personal property in any capacity while volunteering with Special Touch Ministry, Inc. I shall not be insured by Special Touch Ministry, Inc. and I shall be fully responsible for any damage, injury, and legal liability as a result of usage.

I understand this agreement is intended to be as broad and inclusive as permitted by the law and governed by the State of Wisconsin. If any portion thereof is held invalid, it is agreed the balance shall continue in full force and effect.

I understand Special Touch Ministry shall provide occasional, optional, training and support to Chapter Leadership and some of which could be at additional costs to attendees, require travel to Special Touch National Office, and may be eligible for reimbursement by local Special Touch Chapter funds, if available.

CONFIDENTIALITY I understand I may regularly obtain confidential information regarding Special Touch Ministry, Inc.’s programs and services as well as individuals served by them and Special Touch Ministry, Inc. shall rely heavily upon my integrity and good judgment to use all confidential information only in the best interests of Special Touch Ministry, Inc. and not to disclose, divulge, or make accessible confidential information belonging to or obtained through affiliation with Special Touch Ministry, Inc. to any person other than those who have a legitimate need for such information and to whom Special Touch Ministry has authorized disclosure.

POTENTIAL CONFLICT OF INTEREST I understand and agree my activities shall not conflict with the interest of Special Touch Ministry, Inc. during the time of this agreement and I shall not directly or indirectly, operate, manage, consult with, volunteer, or participate in the management or control of another ministry or organization providing the same or similar services to persons with disabilities and their families without notifying Special Touch Ministry, Inc. in writing.

PHOTO RELEASE I give permission to Special Touch Ministry, Inc. to use any individual or group photographs, multi-media images, recordings, and any likeness obtained by or from me during my participation in any Special Touch Ministry, Inc. event and that these shall be used solely for the purposes of Special Touch Ministry, Inc.

INDEMNIFICATION I agree to indemnify, protect, defend, and hold harmless Special Touch Ministry, Inc. and its respective directors, officers, employees, and agents from and against any and all claims, liabilities, losses, damages, injuries, including death, demands, actions, causes of action suits, proceedings, judgments and expenses, including reasonable attorneys' fees, court costs and other legal expenses including, without limitation, those costs incurred at the trial and appellate levels and in any bankruptcy, reorganization, insolvency or similar proceeding, and other legal expenses arising from or connected with any act or omission to act directly or indirectly related to the performance of this Agreement constituting negligence reckless or willful misconduct unless the injury or damage is caused by the sole negligence of Special Touch Ministry, Inc.

BACKGROUND AND REFERENCE CHECKS I authorize the release of criminal records to determine acceptance with Special Touch Ministry, Inc. I authorize Special Touch Ministry, Inc. the right to contact and obtain information from all references and otherwise verify the accuracy of the information contained in the application and subsequent documentation. I hereby release from liability Special Touch Ministry, Inc. and its representative from seeking, gathering and using such information and all other persons, corporations or organizations from furnishing and disclosing information.

COMMUNICATIONS I understand my personal information may be used to contact me with Special Touch Ministry newsletters or other information of interest. I understand that my information may be released only in the event Special Touch Ministry, Inc. has determined as necessary to respond to legal process, to investigate or remedy potential violations of our policies, or to protect the rights, property, and safety of others, as permitted or required by any applicable law, rule, or regulation. I understand that in all other ways my information will be protected and used only for the purposes of Special Touch Ministry, Inc. communications and will not be shared with third parties or other affiliates without my specific approval. I understand that I may opt out of these communications by following unsubscribe links or contacting the Special Touch Ministry National Office and requesting removal.

CERTIFICATION I certify this agreement has been entered into freely and voluntarily without duress. I certify the statements made by me in this application and agreement are true, complete and correct to the best of my knowledge and belief, and are made in good faith. I understand falsification, misrepresentation, or omission of facts called for by this application could result in immediate discontinuation of serving within Special Touch Ministry, Inc. I agree that in the event that I have submitted this application with a copy of my signature by facsimile, email, or digital electronic format to Special Touch Ministry, Inc. I have intended to enter into this agreement and my signature will be legally binding.

I have thoroughly read and understand the STM Chapter Guideline and Policy Manual and under this agreement I shall conform to high professional standards of ethics, perform in line with mission and vision of Special Touch Ministry, Inc, and adhere to the policies, Core Values and Leadership Culture as outlined in these and other policies as communicated by Special Touch Ministry Leadership. I agree at all times, being responsible for my own actions, to act in the best interest of Special Touch Ministry, Inc. and those served by all programs of the organization. I agree not to enter into any signed contract on behalf of Special Touch Ministry, Inc. and represent or obligate Special Touch Ministry, Inc. without the express authorization of Special Touch Ministry, Inc.

COVID-19 POLICIES The safety, well-being, and peace of mind of our Special Touch friends and family is our top priority. As a result, we have implemented health and safety measures aimed at minimizing COVID-19 exposure and preventing its spread. As Special Touch Ministry events span the United States, local restrictions and requirements vary. Each location continues to monitor and make adjustments should the CDC or local authorities recommend different or amended precautionary measures. Chapter attendees needing care should provide their own caregiver to help with personal care needs such as toileting and/or eating. In serving as a Volunteer or Chapter officer you understand you are not providing care on this level and only serving in a supervisory position. We continue our enhanced health and safety measures at all of our events. There is an inherent risk, however, of exposure to COVID-19, or any virus, in any public place where people are present. By participating in any Special Touch Ministry events, you voluntarily assume all risks related to exposure to COVID-19 and Special Touch Ministry disclaims any and all liability related thereto. I also understand and agree that if I have been exposed to or experiencing symptoms of COVID-19, illness, or other contagious disease, I will refrain from participation in Chapter events. Wearing of masks is at individual discretion.

I agree to assume full responsibility for all costs associated with damage or loss of property, medical expenses from sickness or personal injury, or otherwise that may occur as a result of volunteering. I understand I am free to resign at any time by submitting written resignation to Special Touch Ministry National Office and Special Touch Ministry, Inc. reserves the same right to end my position.

BY SIGNING BELOW I AGREE to all terms and conditions of this agreement. This Agreement and all of its terms, covenants and provisions insofar as applicable, shall be binding upon and inure to the benefit of the parties hereto, their respective heirs, executors, administrators, successors and assigns.

Do you understand and agree to the terms listed above? *

I have read *

I have thoroughly read and understand the Chapter Manual.

I Agree *

I understand that as a Chapter Leader I am expected to participate in STM National Chapter Leadership Training when possible. At this time, this includes a 1-hour online Zoom Meeting every other month (6 times per year).

Are you under 18 years of age? *

Contact Phone Number of Parent/Guardian

With your signature in the box below, you confirm that this application has been completed accurately to the best of your knowledge and agree to all Special Touch Ministry terms, conditions, and understandings outlined above (copy) *

Due to state, insurance, and liability policies an annual Chapter Officer/Volunteer Application is required. This information is intended solely for the use of Special Touch Ministry, Inc. programs. An approved background check, completed by Special Touch Ministry, Inc. and three appropriate reference forms are required prior to Application and agreement approval. Each Chapter will be notified of approved Officers & Volunteers following completion.
Please do not begin serving in this capacity until approval has been verified.

Reference forms can be completed online here:

DIRECT LINK: specialtouch.org/stmonlinereference

NOTE: Upon submission, you should receive a confirmation notice on this page AND a copy of your application by email. IF you have not received it, please try completing this application using a different browser or device.

If you are receiving errors when submitting this form completely, use the Save and Resume Later link below to save your information. Then contact us by emailing ministry@specialtouch.org

Special Touch Ministry, Inc.

serving the concerns of people with disabilities

Chapter Leadership Application

This completed application along with social security number and three references (one pastor's and two professional) MUST be submitted to Special Touch National Office by December 1, 2022 for each Chapter Officer and/or Supervisory Volunteer to be approved for 2023.

Personal Information

❷ SELECT THIS LINK and complete the additional information:

Pay attention to the CONFIRMATION REFERENCE NUMBER. This is REQUIRED for background check screening.

Volunteer & Church Activities

New Applicants

Special Touch Ministry Leadership Agreement

Three professional references to be completed must include at least one Pastor. These cannot be relatives, staff, leadership, or leadership applicants of Special Touch Ministry. References are due prior to application deadline date.

This completed application along with social security number and three references (one pastor's and two professional) MUST be submitted to Special Touch National Office by December 1, 2022 for each Chapter Officer and/or Supervisory Volunteer to be approved for 2023.

Personal Information

❷ SELECT THIS LINK and complete the additional information: Pay attention to the CONFIRMATION REFERENCE NUMBER. This is REQUIRED for background check screening.

Volunteer & Church Activities

New Applicants

Special Touch Ministry Leadership Agreement

Three professional references to be completed must include at least one Pastor. These cannot be relatives, staff, leadership, or leadership applicants of Special Touch Ministry. References are due prior to application deadline date.

❷ SELECT THIS LINK and complete the additional information:

Pay attention to the CONFIRMATION REFERENCE NUMBER. This is REQUIRED for background check screening.