HomeMy WebLinkAbout2023 01 30 Regular 502 - Appointment of City Chaplain for 2023 • REGULAR AGENDA ITEM 503
,n m=ared CITY COMMISSION AGENDA I JANUARY 23, 2023 REGULAR MEETING
1959
TITLE
Appointment of City Chaplain for 2023
SUMMARY
The City Commission passed Resolution 2022-27 on October 10, 2022,
authorizing the creation of a voluntary City Chaplain position. Subsequent
discussion followed at the December 12, 2022, City Commission Meeting, and
Staff was directed to advertise the volunteer opportunity and accept
applications from December 13, 2022, through January 12, 2022. During this
period, three (3) applications were submitted and are attached to this item for
review.
Pursuant to Section 2 of Resolution 2022-27, "A City Chaplain shall be chosen
by the City Commission using a secular set of appointment criteria. The City
may appoint multiple Chaplains to serve at one time. Chaplains shall serve for
terms of one year, subject to re-appointment by the Commission."
RECOMMENDATION
Staff recommends the City Commission review the applications and choose a
City Chaplain(s) to serve for a term on one year.
112
RESOLUTION NUMBER 2022-27
A RESOLUTION OF THE CITY COMMISSION OF THE
CITY OF WINTER SPRINGS, FLORIDA, AUTHORIZING
THE CREATION OF A VOLUNTARY CITY CHAPLAIN
POSITION; PROVIDING FOR THE REPEAL OF PRIOR
INCONSISTENT RESOLUTIONS; SEVERABILITY; AND
AN EFFECTIVE DATE.
WHEREAS, the City of Winter Springs is granted the authority,under§ 2(b),Art. VIII of
the State Constitution, to exercise any power for municipal purposes, except when expressly
prohibited by law; and
WHEREAS,it is the intent of the City Commission of the City of Winter Springs,Florida,
to create an unpaid, voluntary City Chaplain position within the City government; and
WHEREAS, governments operating within the United States have a longstanding history
of appointing and working with chaplains at the federal, state, and local level. For example,
chaplains are employed federally in the Veterans Administration, Department of Justice, and the
Department of Defense. The First Congress of the United States utilized the services of a chaplain,
and presently both the United States Senate and the United States House of Representatives have
official chaplains. The State of Florida House of Representatives also utilizes the services of a
chaplain. Local governments have historically used chaplains as well and continue to do so to the
present day. Often local governments appoint chaplains to serve within police departments, fire
departments, schools, and/or hospitals; and
WHEREAS, a chaplain may serve many functions which would be beneficial to the City,
including: providing counseling and support to City employees; acting as a liaison between the
City government and local faith groups;providing invocations before or benedictions after official
City meetings or events; coordinating with local faith groups to schedule guest chaplains to provide
invocations before City meetings;providing spiritual counseling to City personnel as requested by
said personnel; and providing moral support to the City at large during times of crisis; and
WHEREAS, in Town of Greece, N.Y. v. Galloway, 572 U.S. 565 (2014), the Supreme
Court of the United States held that prayer conducted by a chaplain to open town board meetings
does not violate the Establishment Clause of the First Amendment of the United States
Constitution so long as the government does not dictate what religion the chaplain belongs to or
the content of the prayer; and
WHEREAS,in Marsh v.Chambers,463 U.S. 783 (1983),the Supreme Court of the United
States held that the practice of opening legislative sessions with prayer is a part of the fabric of
society deeply rooted in the history and tradition of the nation and therefore does not violate the
Establishment Clause; and
Resolution Number 2022-27
City of Winter Springs, Florida
Page 1 of 4
113
WHEREAS, in Kennedy v. Bremerton School District, 142 S.Ct. 2407 (2022), the
Supreme Court of the United States held that the Establishment Clause must be interpreted by
reference to historical practices and understandings, and that the line that governments must draw
between permissible and impermissible activities under the Establishment Clause must accord with
history and must reflect the understanding of the founders; and
WHEREAS, in Williamson v. Brevard County, 928 F.3d 1296 (11th Cir. 2019), the
Eleventh Circuit Court of Appeals found that a local government violates the Establishment Clause
when it chooses chaplains in a manner which categorically excludes members of certain religions,
or which otherwise engages in discrimination by expressing a preference for chaplains of one
religious denomination over another. The Eleventh Circuit further reasoned that chaplains must be
chosen based upon neutral, secular, criteria to comply with the Establishment Clause; and
WHEREAS, in Atheists of Florida, Inc. v. City of Lakeland,Fla., 713 F.3d 577 (1 lth Cir.
2013), the Eleventh Circuit found that a City's selection process for invocation speakers does not
violate the Establishment Clause if the selection process does not advance or disparage any
particular faith. The Eleventh Circuit further found that the No-Aid Clause of the Florida
Constitution, FL CONST. Art. 1 § 3, is not violated where invocation-givers and chaplains are
unpaid volunteers and where no religious group receives a pecuniary benefit; and
WHEREAS, the City Commission is relying upon the aforementioned legal authority for
the purposes of adopting this Resolution; and
WHEREAS,the City Commission recognizes that the City Chaplain position must not be
used to advance or disparage any particular religion. The City Commission further does not intend
for the Chaplain position to create an excessive entanglement of church and state; and
WHEREAS, the City Commission recognizes that the City Chaplain position shall be
unpaid and voluntary, and that no religious group shall receive a pecuniary benefit in association
with the Chaplain position, and that the City will comport with the requirements of FL CONST. Art.
1 § 3, which provides that "[T]here shall be no law respecting the establishment of religion or
prohibiting or penalizing the free exercise thereof. Religious freedom shall not justify practices
inconsistent with public morals, peace or safety. No revenue of the state or any political
subdivision or agency thereof shall ever be taken from the public treasury directly or indirectly in
aid of any church, sect, or religious denomination or in aid of any sectarian institution;" and
WHEREAS, the City Commission recognizes that City Chaplain positions shall be open
to persons of all faiths and that the Chaplain shall be chosen via a set of secular selection criteria;
and
WHEREAS, the City Commission recognizes that the appointment of chaplains whose
duty is to serve a governmental entity and to provide support to Government officers, agents, and
employees, has a longstanding history and tradition in the United States; and
Resolution Number 2022-27
City of Winter Springs, Florida
Page 2 of 4
114
WHEREAS, the City Commission of the City of Winter Springs hereby finds that this
Ordinance is in the best interests of the public health, safety, and welfare of the citizens of Winter
Springs; and
NOW, THEREFORE, THE CITY COMMISSION OF THE CITY OF WINTER
SPRINGS HEREBY ORDAINS,AS FOLLOWS:
Section 1. Intent and Purpose. This Resolution is intended to have a secular,
non-religious purpose. The intent and purpose of this Resolution is to recognize that there are many
functions a City Chaplain may perform which would be a great benefit to both the City at large
and to City personnel in an individual capacity. The primary effect of this Resolution is neither to
advance nor disparage any particular religion or religious denomination. This Resolution is not
intended to promote or support an unconstitutional entanglement of church and state.
Section 2. Creation of a City Chaplain position. The City Commission hereby
determines that the creation of a voluntary City Chaplain position is consistent with the applicable
State and Federal laws, and in accordance with the Policies and Procedures set forth in EXHIBIT
"A," which is attached hereto and fully incorporated herein by this reference. Accordingly,upon
approval by the City Commission,the position of City Chaplain shall be created. A City Chaplain
shall be chosen by the City Commission using a secular set of appointment criteria. The City may
appoint multiple Chaplains to serve at one time. Chaplains shall serve for terms of one year,subject
to re-appointment by the Commission.
Section 3. Duties of the Chaplain. The general duty of the City Chaplain shall
be to serve the City of Winter Springs during times of need or crisis in accordance with the job
task outlined in EXHIBIT "B," which is attached hereto and fully incorporated herein by this
reference. Without limiting the foregoing, it is the intent of this Resolution that the City Chaplain
be readily available to counsel City personnel, as well their families, and other individuals in the
community who may be in need of the Chaplain's services. The Chaplain shall be responsible for
providing on-call guidance,counseling, consultation,and other forms of human crisis intervention
to those in need. The Chaplain may provide spiritual counseling only to those who specifically
request spiritual counseling.The City Chaplain must express themselves with tolerance and respect
for people of all religions. The City Chaplain shall not discriminate against individuals on the basis
of race, gender, sex,national origin, ability, or religion.
Section 4. Repeal of Prior Inconsistent Resolutions. All prior inconsistent
resolutions adopted by the City Commission, or parts of prior resolutions in conflict herewith, are
hereby repealed to the extent of the conflict.
Section 5. Police Department Chaplain Program. Nothing herein is intended to
repeal or modify the City Chaplain Program established by the Winter Springs Police Department.
The City Chaplain program established by this Resolution is of more general scope than the one
established by the Police Department for police department purposes and shall provide additional
chaplain services in addition to and supplemental to the police department's chaplain program.
Resolution Number 2022-27
City of Winter Springs, Florida
Page 3 of 4
115
Section 6. Severability. If any section, subsection, sentence, clause, phrase,
word,or provision of this Resolution is for any reason held invalid or unconstitutional by any court
of competent jurisdiction, whether for substantive, procedural, or any other reason, such portion
shall be deemed a separate, distinct, and independent provision, and such holding shall not affect
the validity of the remaining portions of this Resolution.
Section 7. Effective Date. This Resolution shall become effective immediately
upon adoption by the City Commission of the City of Winter Springs,Florida,and pursuant to the
City Charter.
ADOPTED by the City Commission of the City of Winter Springs, Florida, in a regular
meeting assembled on the 10th day of October, 2022.
KEVIN McCANN,Mayor
ATTEST:
a�, ! to
n
CH STIAN GOWAN
City Clerk
r � ,
to
X.
APPROVED AS TO LEGAL FORM AND SUFFICIENCY
:THaONY
Y OF WINTER SPRINGS ONLY.
A. GARGANESE
City Attorney
Resolution Number 2022-27
City of Winter Springs,Florida
Page 4 of 4
116
EXHIBIT"A"
RESOLUTION NO.2022-27
CITY CHAPLAIN PROGRAM
POLICIES AND PROCEDURES
CITY OF WINTER SPRINGS CITY COMMISSION
TITLE: REF.No:
CITY CHAPLAIN PROGRAM
Effective: 10/10/2022 Revised:
STANDARDS OF PERFORMANCE
PURPOSE: This directive is to establish guidelines for the operation and management of the City of
Winter Springs City Chaplain Program.
DISCUSSION:The City Chaplain Program is an unpaid,volunteer position occupied by one or more
local clergy members who desire to serve the City during times of distress. The program
is intended to provide citywide coverage,with the services of a Chaplain being made
available to the employees of the City of Winter Springs on an as-needed basis.
POLICY: It is the policy goal of the City of Winter Springs to make readily available counseling
services to City personnel,their families, and other members of the community in need of
such services, either when needed or upon request.To accomplish this policy objective,
the City will maintain a Chaplain Program responsible for providing on-call counseling,
consultation, and other forms of human crisis intervention to those in need. The Chaplain
may also provide spiritual guidance to those who request such guidance.
The goal of the City Chaplain Program is to provide a trusted individual in whom City
personnel as well as citizens of the community may confide and from whom City
personnel may seek assistance in dealing with personal hardships. In addition,the
Program strives to establish and maintain an attitude of cooperation between the City and
the local community.
CHAPLAIN SELECTION CRITERIA:
A. To qualify as a City Chaplain,one must meet the following criteria:
1. Be a resident of the State of Florida.
2. Maintain high moral and ethical standards.
3. Possess a caring and understanding attitude towards all people regardless of race,
national origin, sex,gender, ability,or religion.
City Chaplain Policies and Procedures
City of Winter Springs
Page 1 of 4
117
4. Be willing and able to respond to situations where the presence of a City Chaplain is
required.
5. Have the approval of the City Commission of the City of Winter Springs.
6. Consent to signing the City of Winter Springs Hold Harmless Agreement.
DUTIES AND RESPONSIBILITIES:
A. Assist the City of Winter Springs during times of distress.
B. Visit infirm City employees.
C. Demonstrate appropriate communication skills in formal settings such as official City meetings,
as well as in informal settings.
D. Act as a liaison between the City of Winter Springs and the religious groups of all denominations
located within the City and the surrounding areas.
E. Provide counseling and moral support for City employees, as requested.
F. Attend official City meetings and social events,providing invocations and benedictions, as
requested.
G. Provide spiritual aid and counseling for City employees,as requested.
H. Coordinate with local faith groups to schedule guest Chaplains to provide invocations before City
meetings.
I. Attend City training sessions on a regular basis.
J. Engage in ongoing training to enhance the Chaplain's efficiency in meeting with and assisting
people in crisis.
K. Periodically attend briefing sessions to familiarize themselves with the operations of the City.
L. Remain open and flexible to new concepts and/or additional duties as deemed necessary by the
City Commission.
City Chaplain Policies and Procedures
City of Winter Springs
Page 2 of 4
118
ADDITIONAL INFORMATION:
A. City Chaplains serve on a voluntary basis and at the will of the City Commission.Their services
may be terminated at any time by the City Commission for any reason whatsoever if it is felt that
their involvement in the program is not in the best interest of the City of Winter Springs.
B. The City may appoint multiple Chaplains to serve at one time. Chaplains shall serve for terms of
one year, subject to re-appointment by the Commission.
C. Any information received by the Chaplain while in the performance of their official duties is to
remain in the strictest confidence as allowed by law.
D. Chaplains do not act as an extension of their denomination or faith group. A Chaplain position
may not under any circumstances be used as an opportunity to preach,proselytize,or otherwise
advance any particular religion or belief.
E. The Chaplain may only provide religious counseling if requested by the counselee.If the
counselee does not request spiritual counseling,only secular counseling and support may be
offered.
F. A Chaplain should be willing to become involved in training programs that enhance one's
efficiency in meeting and dealing with people in crisis.
G. A Chaplain should be familiar with community medical,psychiatric, and other aid resources in
the local area.
H. The Chaplain's responsibility is to assist all City employees and their families,upon request,in
matters within the chaplain's professional realm. The chaplain shall not interfere with a City
employee, agent, or official, in the performance of that employee's duty.
I. The Chaplain shall not lend their presence to any political or social movement in a manner that
may suggest the City's endorsement of such a movement. Any such endorsement or advocacy
must be undertaken only as a civilian member of the clergy. Political and social movements are
City Chaplain Policies and Procedures
City of Winter Springs
Page 3 of 4
119
clearly distinguishable from civic office. The Chaplain's role as a public servant must be distinct
from their role as a clergy-member.
ADMINISTRATION OF THE CHAPLAIN PROGRAM:
A. The City Chaplain Program is administered by the City Commission of the City of Winter
Springs.
B. The City Clerk on behalf of the City Commission shall publish and maintain a current list of
approved City Chaplains. Contact information for the City Chaplains is available through the
City's contact directory.
C. All employees,officers, and agents of the City of Winter Springs are authorized to make direct
contact with the City Chaplain for personal reasons.
RELEASING INFORMATION:
A. Members of the City Chaplain Program may not,without prior approval of the City Commission
or City Manager,discuss with the media or other unauthorized persons official City business in
which they may have become involved or have personal knowledge.
Approved by the City Commission by Resolution No.2022-27 on this lot'' day of October, 2022
City Chaplain Policies and Procedures
City of Winter Springs
Page 4 of 4
120
EXHIBIT `B"
RESOLUTION NO. 2022-27
City of Winter Springs
Job Task Analysis
Position: Department: Pay:
Chaplain Citywide Unpaid/Volunteer
General Description:
The general duty of the City Chaplain is to serve the City of Winter Springs during times of need or crisis.They are to be
readily available to counsel City employees,their families,and other individuals in the community in need of support.A
Chaplain is responsible for providing on-call guidance, counseling, consultation, and other forms of human crisis
intervention to those in need.Chaplains must express themselves with respect for people of all religions.
Job Task: Importance Frequency
1. Assist the City of Winter Springs during times of distress. 1 2 3 4 1 2 3 4
2. Visit infirm City employees or members of the community. 1 2 3 4 1 2 3 4
3. Demonstrate appropriate communication skills in formal settings such as official City 1 2 3 4 1 2 3 4
meetings,as well as in informal settings.
4. Act as a liaison between the City of Winter Springs and religious groups of all 1 2 3 4 1 2 3 4
denominations located within the City and the surrounding areas.
5. Provide counseling for City employees and members of the community,as requested. 1 2 3 4 1 2 3 4
6. Attend official City meetings and social events,providing invocations and
benedictions,as requested. 1 2 3 4 1 2 3 4
7. Provide spiritual aid and counseling for City employees and members of the 1 2 3 4 1 2 3 4
community,as requested.
8. Coordinate with local faith groups to schedule guest chaplains to provide invocations 1 2 3 4 1 2 3 4
before City meetings.
1234 1234
9. Attend City training sessions.
1234 1234
10. Engage in ongoing training to enhance the Chaplain's efficiency in meeting with and
assisting people in crisis.
1234 1234
11. Periodically attend briefing sessions to familiarize themselves with the operations of
the City.
These essential job functions are not to be construed as a complete statement or all duties
performed.The Chaplain will be required to perform other job-related marginal duties as
required.
City Chaplain Job Task Analysis
City of Winter Springs
Page 1 of 2
121
Required Qualifications:
• English language fluency. Fluency in Spanish and other languages is helpful.
• Knowledge of general, nonreligious counseling and/or crisis intervention.
• Familiarity with services available in the community to assist persons in crisis, such as local
medical and psychiatric resources, as well as other community aid resources.
• Knowledge regarding spiritual guidance and religious counseling.
• Demonstrated commitment to showing respect to all persons regardless of race, sex, gender,
national origin, ability, or religion.
• Demonstrated dedication to ethics and professionalism.
• Basic knowledge of the function of the local government of the City of Winter Springs and the
Winter Springs City Commission, or willingness to learn about the function of the City
government.
Environmental Conditions:
• Work may be inside in an office environment or outside in the field, as needs dictate.
• May during the day or at night, as needs dictate.
Education and Experience:
• High school graduate or recipient of an acceptable equivalent diploma.
• Education and/or specialized training in providing secular counseling services.
• Experience and/or specialized training in theological counseling.
(A comparable amount of training, education or experience can be substituted for a minimum
qualification).
Licenses and Certifications:
• Theological Training Certificate.
• Certificates in at least one form of non-religious counseling.
Approved by the City Commission by Resolution No. 2022-27 on this 10th day of October,
2022
City Chaplain Job Task Analysis
City of Winter Springs
Page 2 of 2
122
Exhibit"A"
City of Winter Springs
Volunteer Application Form.
Thank you,for considering the City of Winter Springs as an opportunity,for your volunteer
activity. Please provide the.following igfortnation:
Your name: __� 1Y.&J
Your organization: TW CAtXC_k4 Q 4"s
Street Address: L►
City WjAnjn. 0 spgj6a State FL. Zi Z-7 d
Telephone 4W- VU -77-/(P Choose one: Home Business ehilar
Place checks in the following chart to indicate the periods of time which you currently have
available for volunteer activity:
Morning Mid-Day Afternoon Evening
Monday Q 0 0 LI
Tuesday ] El n
Wednesday El 0 0 El
Thursday R El 0
Friday El El
Saturday 0 E 0
Sunday 0 El 0 El
For what volunteer position(s)are you applying?
What skills do you have, such as typing, use of a com ter, artist c abilities, etc.?
-5/0 AGuS P7!VT o,-- k3,ZZOX1 AS 4
Are you under 18 years of age?� I If so, Date of Birth zS&I
Are you currently employed? If yes, where? zed
Are you currently a student? e If yes, where?
Are you a City employee? rya Department?
Are you a retired City employee? A&2 Department?
I am able to volunteer only until: (date) WA
Please describe your areas of interest and describe any related education or work experience.
123
Do you have any prior volunteer experience?
If yes, please describe:
-TAAW 5'eU'bo AaT C-46AWAJ -,69,e— -R4V IA rOSr-caw 70/CMTX A
Are you under care of a medical professional for any physical or psychological treatment that may
affect your ability to safely and satisfactorily perform your volunteer duties?
Have you ever been convicted of, or pled "nolo contendere"to, a felony?
If yes, please explain:
lclbPr�--
I hereby certify that all statements made in connection with.this application,for volunteer work are
true to the best of my knowledge,
Signature Date:
Print Name
I hereby authorize the City of Winter- Springs to obtain a record of my criminal convictions
(including but not limited to pleas of "vola contendere")from the Florida Department of Law
Enforcement or any other agency that collects records of criminal convictions.
Signature Date: Z3
Print Name
Date:
Signature of Parent or Guardian (minors only)
Printed Name of Parent or Guardian (minors only)
124
Exhibit"B"
City of Winter Springs
Standard Volunteer Consent
I agree to read and abide by the policies relating to appropriate behavior and standards of
conduct to be displayed by the City volunteers. I acknowledge that, if at any time such policies are
amended, I will be provided the amended policies and at such time will be responsible for abiding
by any amended provisions of the policy in addition to those included in the original policy.
I further understand and agree to accept the responsibilities of the volunteer position and
participate in any training required by the City. I accept the guidance of my supervisor and shall
notify my supervisor of absences and incidents of injury. I acknowledge that I freely donate my time
without any expectation or promise of compensation. Lastly, I agree to abide by the following in
carrying out my duties and understand that a violation of any of the below statements may result in
my disqualification or termination:
1. I will keep confidential all information as required.
2. I will refrain from publishing any data gathered during the volunteer term and from
disseminating commercial advertisements,press releases,or opinions without prior
written consent of the Human Resources Coordinator.
3. I will refrain from any type of solicitation or charging, requesting or accepting any
fee, gift, reward or payment of any kind for my volunteer services.
4. I will refrain from offering medical and/or legal. advice even though I may be asked
for such.
5. I will maintain a current driver's license and automobile liability insurance if driving
is required as part of my volunteer services.
6. I will.report immediately any suspected incident of abuse to children, dependent
adults, or elders to appropriate authorities and the Human Resources Coordinator.
7. I agree to provide an update to the Human Resources Coordinator of any change to
the information I submitted on my application during the term of volunteer period.
8. I acknowledge that I have read and understand the "External Volunteer Policies"
attached hereto as Attachment"I",and will not engage in inappropriate and/or illegal
conduct or behavior including but not limited to harassment, discrimination, and/or
drug or alcohol abuse.
Signature _. _ Date: / _g--Z?
Print Name
Date:
Signature of Parent or Guardian (minors only)
Printed Name of Parent or Guardian (minors only)
125
Exhibit"C"
City of Winter Springs
City Volunteer Enrollment
Your Name u)J
Organization @ 4V3
Street Address S/7 0,e: � Lon X351
City WIAW 5 AIS Zip 32'7ag'
Telephone No, u7 g Zq — 7Z!Co Choose One: Home Businessa lular
Date of Birth
Emergency Contact Name
Emergency Contact Phone
Relationship
tf your volunteer assigntnent will include driving oroperating a vehicle,please provide the,following
in formation:
Driver's License: o ! ' O Expiration Date: 77ZF _
Auto insurance company:
The following information will he completed by the Human Resources Coordinator:
Volunteer Assignment
Position:
Location:
Supervisor:
Start Date End Date
Background Check Required?Yes/No
Background Check Completion Date:
Vehicle Required? Ycs/No Type:
126
Exbibit"D"
City of Winter,Springs
City Volunteer Release of Liability
In accepting a position as a volunteer-with the City of Winter Springs, I agree to accept voluntary
Workers' Compensation coverage as the sole and exclusive remedy for any injuries I might sustain
while in such volunteer service. Such voluntary Workers' Compensation coverage will be in effect
to pay for medical attention for actual injuries sustained during volunteer service subject to
Workers' Compensation statutes and regulations. Since volunteer service does not include wages,
such compensation does not provide for same.
HOLD HARMLESS AGREEMENT: I agree to hold the City of Winter Springs harmless for any
such injuries and agree not to pursue legal proceedings against the City for any reason associated
with voluntary service except through the Workers' Compensation Act.
Signature of Volu'n-Fe r Date
1
Print Name of Volunteer
Print Form
127
Exhibit"A"
City of Winter Springs
Volunteer Application Form
Thank you for considering the City of Winter Springs as an opportunity for your volunteer
activity. Please provide the following information:
Your name: Robert Melhorn
Your organization: Integrity Church
Street Address: 1425 Tuskawilla Road #145
Winter Springs 32708
City -- - - - State Zip ------
Telephone 407-902-3951 Choose one: Home Business Cellular
Place checks in the following chart to indicate the periods of time which you currently have
available for volunteer activity:
Morning Mid-Day Afternoon. Evening
Monday l [] 0
Tuesday l []
Wednesday l El El 0
Thursday 0 El Q 0
Friday 0 Q 0 0
Saturday Q 0 0 0
Sunday D El El 0
For what volunteer position(s)are you applying? Voluntary City Chaplain
What shills do you have, such as typing, use of a computer, artistic abilities, etc.?
public speaking, counseling, organizational leadership
Are you under 18 years of age? If so, Date of Birth
Are you currently employed? If yes, where? i «�;cycnu�n
Are you currently a student? If yes, where?
Are you a City employee? Department?
Are you a retired City employee? Department?
I am able to volunteer only until: (date)
Please describe your areas of interest and describe any related education or work experience.
have been a parish pastor for over thirty years. I have one unit of clinical pastoral education.
served as hospice chaplain with the Gardner, Massachusetts Visiting Nurse Association.
128
Do you have any prior volunteer experience?
If yes, please describe:
I currently volunteer at the Orange County Academy in Bithlo. I have participated in mission
rips to New York City, New Orleans,Nicaragua, and Haiti.
Are you under care of a medical professional for any physical or psychological treatment that may
affect your ability to safely and satisfactorily perfonii your volunteer duties?
r-
Have
you ever been convicted of, or pled"nolo contendere" to, a felony? h0
If yes, please explain:
I hereby certify that all statements made in connection with this application for volunteer work are
true to the best of m ledge.
Signatures Date: December 21, 2022
Print Name Robert Melhorn
I hereby authorize the City of Winter Springs to obtain a record of my criminal convictions
(including but not limited jo pleas of "nolo contendere")from the Florida Department of Law
Enforcement or any pth gency that collects records of criminal convictions.
Signature - Date: December 21, 2022
Print Name Robert Melhorn
Date:
Signature of Parent or Guardian (minors only)
Printed Name of Parent or Guardian (minors only)
129
Exhibit`B"
City of Winter Springs
Standard Volunteer Consrnt
I agree to read and abide by the policies relating to appropriate behavior and standards of
conduct to be displayed by the City volunteers. I acknowledge that,if at any time such policies are
amended, I will be provided the arnended policies and at such time will be responsible for abiding
by any amended provisions of the policy in addition to those included in the original policy.
I further understand and agree to accept the responsibilities of the volunteer position and
participate in any training required by the City. I accept the guidance of my supervisor and shall
notify my supervisor of absences and incidents of injury. I acknowledge that I freely donate my time
without any expectation or promise of compensation. Lastly, I agree to abide by the following in
carrying out my duties and understand that a violation of any of the below statements may result in
my disqualification or termination:
1. I will keep confidential all information as required.
2. 1 will refrain from publishing any data gathered during the volunteer term and from
disseminating commercial advertisements,press releases, or opinions without prior
written consent of the Human Resources Coordinator.
3. 1 will refrain from any type of solicitation or charging, requesting or accepting any
fee, gift,reward or payment of any kind for my volunteer services.
4. 1 will refrain from offering medical and/or legal advice even though I may be asked
for such.
5. 1 will maintain a current driver's license and automobile liability insurance if driving
is required as part of my volunteer services.
b. I will report immediately any suspected incident of abuse to children, dependent
adults, or elders to appropriate authorities and the Human Resources Coordinator.
7. I agree to provide an update to the Human Resources Coordinator of any change to
the information I submitted on my application during the term of volunteer period.
8. 1 acknowledge that I have read and understand the "External Volunteer Policies"
attached hereto as Attachment"1",and will not engage in inappropriate and/or illegal
conduct or havior including but not limited to harassment, discrimination, and/or
drug a hol abuse.
7s
Signature Date:.
Print Namer l Ly i
Date:
Signature of Parent or Guardian (minors only)
Printed Name of Parent or Guardian (minors only)
130
Attachment 1.
External Volunteer Policies
1. Volunteers are at-will. The City accepts the service of all volunteers with the understanding that
such service is at the sole discretion of the City. Volunteers agree that the City may at any time,for
whatever reason,decide to terminate the volunteer's relationship with the City. The volunteer may
at any time,for whatever reason,decide to sever the volunteer's relationship with the City_ Notice
of such a decision should be communicated as soon as possible to the volunteer's supervisor.
2. No conflicts of interest: No person who has a conflict of interest under Florida law with any activity
or program of the City shall be accepted or serve as a volunteer with the City.
3. Dress Code_Volunteers shall dress appropriately for the conditions and performance of their duties.
4. Inappropriate Conduct, Discrimination and Harassment Prohibited: The City is an Equal
Opportunity Employer and is committed to providing a workplace free of any type of unlawful
discrimination or harassment.
(i) Volunteers are prohibited from engaging in any type of inappropriate conduct,including but
not limited to unlawful discrimination or harassment on the basis of race,religion,national
origin,ethnicity,age,gender,marital status,pregnancy,disability,veteran status and/or any
other legally protected characteristic.
(ii) Volunteers are prohibited from engaging in unlawful harassment including verbal,physical
and visual conduct based on any of the above legally protected characteristics which create
an intimidating,offensive or hostile work environment or that interferes or could interfere
with a volunteer's work performance. Some examples of harassment include racial slurs or
jokes, disparaging remarks concerning any protected group, ethnic jokes, distribution or
posting of offensive statements,posters or cartoons or other similar conduct.
(iii) Volunteers are prohibited from engaging in sexual harassment. Sexual Harassment may
exist where a volunteer requests sexual favors or makes unwelcome sexual advances
towards another individual or makes unwelcome verbal comments or displays physical
conduct of a sexual nature to another individual, where the comment or conduct is
unwelcome. Sexual harassment may also exist where a volunteer makes derogatory
comments to an individual based on or related to such person's gender.
(iv) Volunteers must report any incident involving any perceived discrimination and/or
harassment experienced or witnessed by them immediately to their Supervisor and to the
Department Head, as defined herein, and to the Human Resources Coordinator ("W').
Volunteers should recognize that this policy applies equally to harassment or discrimination
committed by a fellow volunteer,employee,citizen, elected official,vendor or other third
parties with whom the volunteer comes into contact_
(v) Every complaint of unlawful discrimination or harassment that is reported will be
investigated thoroughly and promptly. Retaliation against any volunteer for making such
a complaint is strictly prohibited. The complainant will be made aware of the outcome of
the City's investigation upon completion. If the investigation reveals reasonable cause to
believe that unlawful discrimination or harassment has occurred,the City will take prompt
remedial action to stop the impermissible conduct, prevent it from occurring in the future
and to appropriately discipline the person responsible.
131
(vi) Any volunteer violating this policy is subject to discipline,up to and including termination
of volunteer services. If you have questions regarding this policy or the City's complaint
procedure, please direct your questions to the Human Resources Coordinator.
5. Substance Abuse Prohibited: The City is determined to eliminate the use of illegal drugs,alcohol,
and controlled substances at its work sites. Volunteers are prohibited from use of such substances
at all City work sites and volunteer sites. Use of illegal drugs,alcohol and controlled substances at
City work sites or volunteer sites may result in discipline, up to and including termination of
volunteer services.
132
Exhibit"C"
City of Winter Springs
(( City Volunteer Enrollrient,
Your Name MeAyen
Organization - 1 &r;r �c
Street Address ;4 M Cin C le-
City
Telephone No. 4D7-` a-_ i. Choose One: Home Business Cellular
Date of Birth
f
Emergency Contact Name
Emergency Contact Phone q,97--,jC 2-S-j35
Relationship
If your volunteer assignment will include driving or operating a vehicle,please provide the following
information:
Driver's Licenser `�' llf �?�' �[.� Expiration Date: i9l
Auto insurance company: fs4 .
The following information will be completed by the Human Resources Coordinator.-
Volunteer
oordinator:Volunteer Assignment
Position:
Location:
Supervisor:
Start Date End Date
Background Check Required?Yes/No
Background Check Completion Date:
Vehicle Required? Yes/No Type:
133
Exhibit"D"
City of Winter Springs
City Volunteer Release of Liability
In accepting a position as a volunteer with the City of Winter Springs, I agree to accept voluntary
Workers' Compensation coverage as the sole and exclusive remedy for any injuries I might sustain
while in such volunteer service. Such voluntary Workers' Compensation coverage will be in effect
to pay for medical attention for actual injuries sustained during volunteer service subject to
Workers' Compensation statutes and regulations. Since volunteer service does not include wages,
such compensation does not provide for same.
HOLD HARMLESS AGREEMENT: I agree to hold the City of Winter Springs harmless for any
such injuries and agree not to pursue legal proceedings against the City for any reason associated
with voluntary service except through the Workers' Compensation Act.
rlfl!i d+?✓
Signature of Volunteer Date
Print Name of Volunteer
134
CITY OF WINTER SPRINGS
VOLUNTEER POLICY
A. Purpose.
The volunteers of the City of Winter Springs play a vital role in the enhancement of public services
provided by each City department. Accordingly,this Policy is designed to guide the intake of City
volunteers for placement in the volunteering opportunities throughout the City of Winter Springs.
B. Volunteer: Definition; General Policies.
1. Definition: For purposes of this Policy,a volunteer is an individual who performs
hours of service in a City department for civic, charitable, health, humanitarian,
recreational,public safety or general welfare reasons,without promise,expectation
or receipt of compensation for services rendered, except for reimbursement of
expenses, nominal fees, or a combination thereof.
(i) This policy applies only to non-elected volunteers. This policy
does not include volunteers appointed to a City board or
committee.
(ii) Volunteers do not supplant City employees; they assist paid staff
or provide services that constitute elements of major regular
positions and augment the established and mandated services of the
City.
(iii) City employees may volunteer their services to the City as long as
the work they perform as a volunteer is outside their scope of
duties as City employees.
(iv) Individuals or entities that are (1) volunteering or working for
independent contractors hired by the City or (2) individuals or
associations retained by the City by separate agreement are not
volunteers of the City for purposes of this Policy.Such volunteers
under separate agreement shall be subject to the terms and
conditions of such agreement.
2. Minors: Volunteers who have not reached the age of eighteen years must have the
written consent of a parent or legal guardian prior to volunteering.
C. City Manager or Commission Approval Required.
1. All City volunteer positions shall require prior approval by the City Manager, the
City Manager's designee, or the City Commission. Such approval shall be based
on whether the volunteer position furthers the purpose of a City department.
City of Winter Springs
Volunteer Policy
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135
2. City departments may make requests to the City Manager for volunteer
authorization based on the needs of the Department. When making such a request,
the Department shall provide the following information:
(i) the purpose and scope of proposed duties for the volunteer position;
(ii) the Department's need for the volunteer position; and
(iii) any special qualifications required of a successful applicant.
D. Application and Enrollment Process.
1. The process for selection of City volunteers is as follows:
(i) Applicants must submit a completed Volunteer Application Form to the
supervisor of the volunteer position for which the application is submitted
("Supervisor"). The Supervisor shall then forward such applications to the
head of the City Department that is seeking to fill such volunteer position
("Department Head"). The Department Head shall forward a copy of all
such applications to HR for record-keeping purposes.
(ii) The Department Head shall review Volunteer Application Forms received
and may select applicant(s) for interview(s).
(iii) The Department Head may conduct one or more interviews of each selected
applicant, in the discretion of the Department Head. Prior to being
assigned to a position, all volunteers will be interviewed to ascertain their
suitability for and interest in the position. The interview should determine
the qualifications of the volunteer, their commitment to fulfill the
requirements of the position, and should answer any questions that the
volunteer might have about the position.
(iv) Upon making an initial determination that an applicant is qualified for a
volunteer position,the Department Head shall request that HR provide the
required background checks and screening as set forth in Paragraph E of
this Policy.
(v) HR shall determine, in its discretion and in accordance with law, whether
an applicant's background checks and screening reveal any disqualifying
information. If there is no such disqualifying information, HR shall
authorize the applicant for the volunteer work. The applicant may
commence work as a City volunteer upon HR's authorization.
2. Enrollment. All City volunteers shall read, sign, and submit the following forms
City of Winter Springs
Volunteer Policy
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136
prior to commencing their term as a City volunteer:
(i) City Volunteer Application form, attached hereto as Exhibit"A";
(ii) City Standard Volunteer Consent form, attached hereto as Exhibit"B";
(iii) City Volunteer Enrollment form, attached hereto as Exhibit"C"; and
(iv) City Volunteer Release of Liability form, attached hereto as Exhibit"D".
The Department Head is responsible for forwarding all such forms to HR for
record-keeping.
3. HR shall establish record-keeping procedures and maintain City volunteer records
as required by Florida Statutes.
E. Screening and Background Checks.
1. Sensitive Positions. A criminal background investigation shall be completed
on all volunteers applying for a sensitive position, as identified in Section
E(2), herein. Each City department has the authority to determine which
volunteer assignments constitute sensitive positions.
The applicant must sign the statement set forth on the Volunteer Application
Form authorizing the City to conduct a criminal background investigation
prior to initiation of such background check. A volunteer may not commence
volunteer services until after completion of such background check.
In evaluating whether a volunteer applicant may be rejected for work
placement or transfer to a sensitive position,HR shall consider the following
criteria:
(i) The nature and seriousness of the offense(s), and the
circumstances under which the offense(s) occurred;
(ii) The age of the person at the time of the offense(s);
(iii) The recency of the offense(s);
(iv) The number of convictions;
(v) The relationship of the offense(s)to the sensitive position for
which application is made;
City of winter Springs
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137
(vi) Evidence of rehabilitation and maturation, including the
volunteers employment record with respect to job
responsibility and duration and other volunteer efforts;
(vii) Truthfulness in admitting previous record;
(viii) Attitude of applicant;
(ix) Other factors relevant to the volunteer's suitability,including
but not limited to maturity, attitude and honesty.
2. Guidelines for Identifying Sensitive Positions: A sensitive position may
include,but is not limited to,positions that involve access to custody of cash,
equipment or confidential information;involves the rendering of services to
at-risk persons (such as children or the elderly); or involves dispensing City
benefits to the public.
3. Contact with At-Risk Persons. Where volunteers are to be placed in direct
contact with at-risk persons (such as children or the elderly), additional
screening procedures may be instituted. These procedures may include
reference checks, direct background investigation, criminal investigation,
etc.,as authorized or required by law. Volunteers who refuse permission for
conduct of these checks will not be accepted for the volunteer position.
4. Potentially Disqualifying Job-Related Offenses: The following is a list of
offenses in general/common terms, which,under certain conditions,may be
incompatible with specific functions associated with volunteer work
assignments; however, the list is intended only as a guide, is not
comprehensive, and does not reference specific statutory terms:
(i)List of Offenses
Function -Access to funds or negotiable instruments
Bribery
Embezzlement
Forgery
Fraud
Receiving Stolen Property
Robbery
Theft
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Function -Access to confidential or classified materials
Extortion
Forgery
Fraud
Perjury
Receiving Stolen Property
Robbery
Theft
Function -Charge of or access to City property
Embezzlement
Robbery
Receiving Stolen Property
Theft
Function -Protection of persons or property(Law Enforcement)
Assault
Drug or Narcotics Offenses
Child Molestation/Abuse
Embezzlement
Forgery
Fraud
Homicide
Intoxication
Kidnapping
Robbery
Sex Offenses
Theft
Function -Individual contact with or care or supervision of minors
Assault
Child Molestation/Abuse
Chronic or Recurrent Alcoholism
Drug or Narcotics Offenses
Homicide
Kidnapping
Manslaughter
Offenses Against Minors
City of winter Springs
Volunteer Policy
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139
Sex Offenses
Rape
Robbery
Theft
Function -Individual contact with or care or supervision of the elderly
Assault
Child Molestation/Abuse
Drug or Narcotics Offenses
Embezzlement
Forgery
Fraud
Homicide
Intoxication
Kidnapping
Manslaughter
Rape
Receiving Stolen Property
Robbery
Sex Offenses
Theft
5. Certification and Licensing. Violation of any certification or licensing
requirements relating to the duties of the position in question may be the
basis for disqualification.
(A) The City recognizes that in some cases, volunteers must have
certification or a license in order to provide certain volunteer services.
To the extent that the City requires such a volunteer, and the
volunteer does not yet have the required certificate or license,the City
Manager may authorize, in the City Manager's discretion, the
expenditure of City funds for the purpose of assisting the volunteer
in obtaining such certification or license needed to provide the
services required by the City. However, if said funds are paid by the
City, the City Manager may require the volunteer to commit, in
writing,to providing said services for a specific period of time,or the
volunteer will be required to repay the funds to the City. This
provision does not obligate the City to expend funds for any volunteer
in need of certification or licensing for the performance of any
volunteer services.
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140
6. Dishonesty in Application. Dishonesty during the application process for a
volunteer position may be the basis for disqualification.
7. Criminal background data obtained for employment screening purposes
pursuant to Chapter 435, Florida Statutes, shall be used only for such
screening purposes. Such data shall be kept confidential and is exempt
from the Public Records Law.
8. Medical Treatments. Any potential volunteer who indicates that they are
under the care of a physician for either physical or psychological treatment
may be asked to present a certificate from the physician as to their ability to
satisfactorily and safely perform their volunteer duties. Volunteers under a
course of treatment which might affect their volunteer work will not be
accepted without written verification of suitability from their physician.
Any volunteer who, after acceptance and assignment by the City, enters a
course of treatment which might adversely impact upon the performance of
their volunteer duties should consult with their supervisor.
F. Orientation and Training.
1. Orientation. All volunteers will receive a general orientation on the nature
and operation of the program or activity for which they are recruited, and a
specific orientation on the purposes and requirements of the position which
they are accepting in that effort.
2. On-the-Job Training. Volunteers will receive specific on-the-job training to
provide them with the information and skills necessary to perform their
volunteer assignment. The timing and methods for delivery of such training
should be appropriate to the complexity and demands of the position and the
capabilities of the volunteer.
G. Supervision. Volunteers shall be supervised by the Department Head, or the
Department Head's designee.
City of winter Springs
Volunteer Policy
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141
Exhibit "A"
City of Winter Springs
Volunteer Application Form
Thank you for considering the City of Winter Springs as an opportunity for your volunteer
activity. Please provide the following information:
Your name: Rev. Kyle Stewart
Your organization: Trinity Presbyterian Church of Winter Springs
Street Address: 509 Marr Run
City Winter Springs state zip 32708
Telephone 4435100078 Choose one: Home Business Cellular
Place checks in the following chart to indicate the periods of time which you currently have
available for volunteer activity:
Morning Mid-Day Afternoon Evening
Monday 0 0 0 ❑
Tuesday 0 0 0 0
Wednesday 0 0 0 0
Thursday 0 El El 0
Friday 0 0 0 0
Saturday j 0 0 0 0
Sunday I ❑ ❑ El ❑
For what volunteer position(s)are you applying?
What skills do you have, such as typing, use of a computer, artistic abilities, etc.?
anifold. I've been in publishing, run an automotive computer business, etc.
Are you under 18 years of age? If so, Date of Birth
Are you currently employed? If yes, where?Trinity Presbyterian Church of W.S.
Are you currently a student? If yes, where?
Are you a City employee? Department?
Are you a retired City employee? Department?
I am able to volunteer only until: (date)
Please describe your areas of interest and describe any related education or work experience.
am interested in serving as a volunteer city chaplain.
142
Do you have any prior volunteer experience?
If yes, please describe:
have served as a volunteer in numerous civic capacities since I was a child.
Are you under care of a medical professional for any physical or psychological treatment that may
affect your ability to safely and satisfactorily perform your volunteer duties?
o.
Have you ever been convicted of, or pled"nolo contendere"to, a felony?
If yes, please explain:
I hereby certify that all statements made in connection with this application for volunteer work are
true to the best of my knowledge.
Signature x Date: 01.01.23
Print Name Kyle tewart
I hereby authorize the City of Winter Springs to obtain a record of my criminal convictions
(including but not limited to pleas of "nolo contendere")from the Florida Department of Law
Enforcement or any other agency that collects records of criminal convictions.
Signature 4Date: 01.01.23
Print Name Kyle tewart
Date:
Signature of Parent or Guardian(minors only)
Printed Name of Parent or Guardian(minors only)
143
Exhibit`B"
City of Winter Springs
Standard Volunteer Consent
I agree to read and abide by the policies relating to appropriate behavior and standards of
conduct to be displayed by the City volunteers. I acknowledge that, if at any time such policies are
amended, I will be provided the amended policies and at such time will be responsible for abiding
by any amended provisions of the policy in addition to those included in the original policy.
I further understand and agree to accept the responsibilities of the volunteer position and
participate in any training required by the City. I accept the guidance of my supervisor and shall
notify my supervisor of absences and incidents of injury. I acknowledge that I freely donate my time
without any expectation or promise of compensation. Lastly, I agree to abide by the following in
carrying out my duties and understand that a violation of any of the below statements may result in
my disqualification or termination:
1. I will keep confidential all information as required.
2. I will refrain from publishing any data gathered during the volunteer term and from
disseminating commercial advertisements,press releases, or opinions without prior
written consent of the Human Resources Coordinator.
3. I will refrain from any type of solicitation or charging, requesting or accepting any
fee, gift, reward or payment of any kind for my volunteer services.
4. I will refrain from offering medical and/or legal advice even though I may be asked
for such.
5. I will maintain a current driver's license and automobile liability insurance if driving
is required as part of my volunteer services.
6. I will report immediately any suspected incident of abuse to children, dependent
adults, or elders to appropriate authorities and the Human Resources Coordinator.
7. I agree to provide an update to the Human Resources Coordinator of any change to
the information I submitted on my application during the term of volunteer period.
8. I acknowledge that I have read and understand the "External Volunteer Policies"
attached hereto as Attachment"1",and will not engage in inappropriate and/or illegal
conduct or behavior including but not limited to harassment, discrimination, and/or
drug or alcohol abuse.
Signature 44 Date: 01 .01 .23
Print Name Kyle St Wart
Date:
Signature of Parent or Guardian(minors only)
Printed Name of Parent or Guardian(minors only)
144
Attachment 1.
External Volunteer Policies
1. Volunteers are at-will: The City accepts the service of all volunteers with the understanding that
such service is at the sole discretion of the City. Volunteers agree that the City may at any time,for
whatever reason,decide to terminate the volunteer's relationship with the City. The volunteer may
at any time,for whatever reason,decide to sever the volunteer's relationship with the City. Notice
of such a decision should be communicated as soon as possible to the volunteer's supervisor.
2. No conflicts of interest: No person who has a conflict of interest under Florida law with any activity
or program of the City shall be accepted or serve as a volunteer with the City.
3. Dress Code:Volunteers shall dress appropriately for the conditions and performance of their duties.
4. Inappropriate Conduct, Discrimination and Harassment Prohibited. The City is an Equal
Opportunity Employer and is committed to providing a workplace free of any type of unlawful
discrimination or harassment.
(i) Volunteers are prohibited from engaging in any type of inappropriate conduct,including but
not limited to unlawful discrimination or harassment on the basis of race,religion,national
origin,ethnicity,age,gender,marital status,pregnancy,disability,veteran status and/or any
other legally protected characteristic.
(ii) Volunteers are prohibited from engaging in unlawful harassment including verbal,physical
and visual conduct based on any of the above legally protected characteristics which create
an intimidating,offensive or hostile work environment or that interferes or could interfere
with a volunteer's work performance. Some examples of harassment include racial slurs or
jokes, disparaging remarks concerning any protected group, ethnic jokes, distribution or
posting of offensive statements,posters or cartoons or other similar conduct.
(iii) Volunteers are prohibited from engaging in sexual harassment. Sexual harassment may
exist where a volunteer requests sexual favors or makes unwelcome sexual advances
towards another individual or makes unwelcome verbal comments or displays physical
conduct of a sexual nature to another individual, where the comment or conduct is
unwelcome. Sexual harassment may also exist where a volunteer makes derogatory
comments to an individual based on or related to such person's gender.
(iv) Volunteers must report any incident involving any perceived discrimination and/or
harassment experienced or witnessed by them immediately to their Supervisor and to the
Department Head, as defined herein, and to the Human Resources Coordinator ("HR").
Volunteers should recognize that this policy applies equally to harassment or discrimination
committed by a fellow volunteer, employee, citizen, elected official,vendor or other third
parties with whom the volunteer comes into contact.
(v) Every complaint of unlawful discrimination or harassment that is reported will be
investigated thoroughly and promptly. Retaliation against any volunteer for making such
a complaint is strictly prohibited. The complainant will be made aware of the outcome of
the City's investigation upon completion. If the investigation reveals reasonable cause to
believe that unlawful discrimination or harassment has occurred,the City will take prompt
remedial action to stop the impermissible conduct, prevent it from occurring in the future
and to appropriately discipline the person responsible.
145
(vi) Any volunteer violating this policy is subject to discipline,up to and including termination
of volunteer services. If you have questions regarding this policy or the City's complaint
procedure,please direct your questions to the Human Resources Coordinator.
5. Substance Abuse Prohibited. The City is determined to eliminate the use of illegal drugs,alcohol,
and controlled substances at its work sites. Volunteers are prohibited from use of such substances
at all City work sites and volunteer sites. Use of illegal drugs,alcohol and controlled substances at
City work sites or volunteer sites may result in discipline, up to and including termination of
volunteer services.
146
Exhibit"C"
City of Winter Springs
City Volunteer Enrollment
Your Name Rev. Kyle Stewart
Organization Trinity Presbyterian Church of Winter Springs
Street Address 509 Mark Run
City Winter Springs Zip 32708
Telephone No. 443.510.0078 Choose One: Home Business Cellular
Date of Birth 04.19.1980
Emergency Contact Name Corey Stewart
Emergency Contact Phone 443.510.0077
Relationship Wife
If your volunteer assignment will include driving or operating a vehicle,please provide the following
information:
Driver's License: 5363-503-80-139-0 Expiration Date:04.19.30
Auto insurance company:Gelco
Thefollowing- information will be completed by the Human Resources Coordinator:
Volunteer Assignment
Position:
Location:
Supervisor:
Start Date End Date
Background Check Required?Yes/No
Background Check Completion Date:
Vehicle Required? Yes/No Type:
147
Exhibit"D"
City of Winter Springs
City Volunteer Release of Liability
In accepting a position as a volunteer with the City of Winter Springs, I agree to accept voluntary
Workers' Compensation coverage as the sole and exclusive remedy for any injuries I might sustain
while in such volunteer service. Such voluntary Workers' Compensation coverage will be in effect
to pay for medical attention for actual injuries sustained during volunteer service subject to
Workers' Compensation statutes and regulations. Since volunteer service does not include wages,
such compensation does not provide for same.
HOLD HARMLESS AGREEMENT: I agree to hold the City of Winter Springs harmless for any
such injuries and agree not to pursue legal proceedings against the City for any reason associated
with voluntary service except through the Workers' Compensation Act.
kA 01.01.23
Signature of Volunteer Date
Kyle Stewart
Print Name of Volunteer
Print Form