What's your email address?

Your information

Required fields are marked with an asterisk (*).
First Name *
Last Name *
Phone Number *

For example, 123-456-7890
SMS/text messaging: By providing your mobile number and checking the box below, HACAP will be allowed to send you SMS (text) messages relating to their volunteer activities. To opt-out, reply STOP to any SMS message OR return to this form and uncheck the box.
Address *
City *
State *
ZIP Code *
I am interested in helping with the following:

Please note that our Head Start volunteer positions will require some additional paperwork and require a background check.
Race *
Hispanic/Latino: *
Sex (Gender) *
Date of Birth *


CONFIDENTIALITY STATEMENT: Disclosure of confidential information gained through your employment or as a volunteer by Hawkeye Area Community Action Program, Inc. is an act of prohibited conduct subject to formal disciplinary action. Any information concerning a client, family, financial condition or personal peculiarities is strictly confidential. When a client’s history or condition is reviewed, it must be done in privacy with only those persons involved with the client. Any other information coming to you in the course of your work concerning another person or employee is also considered confidential and may not become the topic of conversation with others.

RELEASE OF LIABILITY: I hereby understand that my activities at HACAP are voluntary, having been initiated on my part. I release HACAP of any and all liability should my activity at HACAP result in personal injury or personal property damage.

PHOTO RELEASE: I voluntarily give my permission for HACAP to take photographs and/or videotapes and use them in a publicly-identifiable manner for promotional, informational or other purposes HACAP deems suitable for an undetermined period of time, including but not limited to use on HACAP Social Media and website. I understand that I will receive no compensation for my participation. I agree that any photographs, tape recordings, and/or videotapes remain HACAP property. To the fullest extent allowed by law, I release HACAP and its representatives from any and all liability associated with the use of said photographs, tape recordings and/or videotapes.

FOOD & WAREHOUSE SAFETY: The HACAP food reservoir is a working food distribution facility and because of that, food safety and your personal safety are important to us. The following safety measures must be followed at all time while in the warehouse: No open toed shoes or loose jewelry. Please leave your valuables locked in your vehicle or keep them on your person. Eating, drinking in the warehouse, or smoking on HACAP property is not permitted. We will provide volunteer/visitor badges and food safety training at the beginning of each volunteer event.

When you are volunteering:
• Please wash your hands before and after your shift
• All people working with food and/or distribution must be in good physical health with clean hands and no broken/exposed skin
• Gloves must be worn when handling meat of any type and when handling fresh produce
• If you are experiencing any of the following symptoms, please do not report to your scheduled volunteer time: Fever, Vomiting, Diarrhea, Jaundice, Current Foodborne Illness Diagnosis