Thank you for deciding to become a West Seattle Timebank member.
Before completing this application, read the Become a Member page to learn all the steps to becoming a member. When you’re ready, fill in the application below. If you have any questions or difficulty with the form, please Contact Us for help.

* indicates required fields.

Basic information


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Phone type?*  Home Work Cell

How did you hear about the West Seattle Timebank?*
 Friend Poster Internet Organization Other

Background Check

We require a background check for all members.
Are you willing to have a background check?*
Yes

Birth date*

Personal, Professional or Volunteer References

Please list a reference not related to you and let them know they may be contacted.

Release of Liability & Membership Agreements

Please read the terms below, then click the checkbox at the bottom to Agree.

  • I understand that the references, employers and volunteer organizations I have provided may be contacted and that the TimeBank may do a background check on applicants.
  • Members of the TimeBank offer neighborly services or skills to one another as volunteers. The TimeBank is a coordinating agency only; it is not responsible for the services performed by TimeBank members. Prior to receiving a service, it is my responsibility to ascertain the competency of the server to deliver that service to my satisfaction.
  • The TimeBank cannot be held responsible for any injury to persons or damage to property experienced while involved with the program. I agree to hold the TimeBank, as well as its employees and/or agents, harmless from any and all claims or liabilities for any activities performed by a TimeBank volunteer.
  • I agree to take responsibility for any accident or injuries that I might suffer while on property owned or rented by any TimeBank member and waive any claim against that member.
  • I agree that if I use my personal vehicle in rendering volunteer service through the TimeBank, I will first obtain Senior Services Transportation Program approval and, in accordance with Washington law, arrange to keep in effect legal automobile liability insurance covering bodily injury and property damage.
  • I agree that I will accept no monetary payment for services, or no monetary reimbursement for driving with the Senior Services Transportation Program as a Timebank driver.

I agree to these terms and certify that the information given on this form is accurate to the best of my knowledge.

Signature

Type your name and date below to sign this application.

Signature of Parent or Guardian (if under 18)

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