Volunteer Application Form

I hereby authorize The Psychological Center, Inc., its representatives and employees, the right to take photographs of me to use, reproduce, and/or publish in any written, audio and/or visual materials, including photographs (which are described below) that may pertain to me. I understand that this material may be used in various publications, press releases, newspapers, internet or for other related endeavors. This material may also appear on The Psychological Center, Inc. website. This authorization is continuous and may only be withdrawn by my specific rescission of the authorization in writing. Consequently, The Psychological Center, Inc. may publish materials, use my name, photograph and/or make reference to me in any manner that they deem appropriate to promote/publicize service opportunities.

I understand and agree that submitting this application form does not automatically register me as a Psychological Center volunteer, and that there may be certain qualifications I must meet, including a volunteer orientation.