Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

Volunteer Screening and Hours Tracking Form

  1. Instructions

    Volunteers must complete this form before each shift to screen for COVID-19 symptoms and agree to terms and conditions.

  2. VOLUNTEER INFORMATION

  3. Select the date of your scheduled volunteer shift.

  4. List the time range you will volunteer, from the time you check-in through the time you check-out. The format is h:mm - h:mm (example: 9:00 - 2:00).

  5. List the total number of volunteer hours you will work in the time frame reported (example: 2.5 hours).

  6. COVID-19 SYMPTOM SELF-SCREENING FOR VOLUNTEERS

    Volunteers should answer the following screening questions prior to the start of their shift. In the last 72 hours, have you had any of the following:

  7. A new fever (100.4°F or higher), or a sense of having a fever?*

  8. A new cough that you cannot attribute to another health condition?*

  9. New shortness of breath that you cannot attribute to another health condition?*

  10. A new sore throat that you cannot attribute to another health condition?*

  11. New muscle aches that you cannot attribute to another health condition (or aches caused by physical exercise)?*

  12. New gastrointestinal symptoms, such as nausea, vomiting or diarrhea that you cannot attribute to another health condition?*

  13. New loss of taste or smell that you cannot attribute to another health condition?*

  14. A new headache that you cannot attribute to another health condition?*

  15. In the last 14 days, have you had close contact with a person who was known to be COVID-19 positive, or had flu-like symptoms, at the time you had close contact with them?*

  16. In the last 14 days, have you tested positive or are presumptive positive for COVID-19?*

  17. If you answered "YES" to any of the questions above, please do not show up for your shift. Instead, email Shelby Krogh, Volunteer & Special Event Coordinator, at shelby.krogh@bothellwa.gov to cancel your RSVP.

  18. VOLUNTEER AGREEMENT

  19. I AGREE TO THE FOLLOWING:*

    I acknowledge that there may be special dangers and risks inherent in my voluntary participation in activities sponsored by the City of Bothell. These risks may be apparent or hidden, known or unknown. These risks are to be taken into consideration in deciding to volunteer, whether my participation is just one time or on multiple occasions. These risks include the possibility of physical injury, loss, death, damage, or other consequences that may arise or result directly from any activity in which I may participate in during this program/project. I desire to participate having determined of my own free will and personal assessment of the risks that I am qualified to participate and willing to accept the risks involved. In consideration of the privilege of participating in this program/project and utilizing any necessary tools, or accessing any public or private property, I hereby assume all risk of personal injury, loss, death, damage, or other consequences. I also forever discharge and waive any right of recovery from, or to bring a claim or lawsuit against, the owners and/or developers of private property which I may need to occupy or cross to access a stream, wetland, field, or project site; and the City of Bothell, its officials, employees, contractors, and other volunteers, agreeing to hold them harmless from any and all claims of negligence for any personal injury, loss, death, damage, or other consequences that I may suffer participating as a volunteer working on activities sponsored by the City of Bothell.

  20. Type your name as your electronic signature confirming the information within.

  21. Leave This Blank:

  22. This field is not part of the form submission.