Court Mandated Service Form

Serve by filling out online Information Form below or download PDF and fill out by hand.


Bountiful Basket Court Mandated Service Form

Bountiful Basket Food Shelf Court Mandated Service Form

Bountiful Basket Food Shelf can only accept volunteers with non-violent offenses. We will be contacting you soon.

PERSONAL INFORMATION

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Name(Required)
Address(Required)
What site are you interested in volunteering at?
Do you speak another language (other than English)?
Interest Inventory
Check all that apply

AVAILABILITY

Days Available:
Time of Day:
Commitment:

BOUNTIFUL BASKET FOOD SHELF RELEASE FOR STATE BACKGROUND CHECK

Bountiful Basket Food Shelf of Eastern Carver County is a Non-profit 501c (3) and requires all volunteers to pass a background check prior to working with guests. Please complete the information listed below.
Name(Required)
Address(Required)
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Answering ‘yes’ to the following questions does not constitute automatic bar from volunteering at Bountiful Basket. Factors such as the date of offense, seriousness, nature of the violation, and rehabilitation, will be taken into account.
Have you ever pled “guilty” or “no contest” to, or been convicted/charged with a federal crime or felony offense?(Required)
Have you ever been known by any other name(s) in the last 7 years? If yes, please identify:
MM slash DD slash YYYY

BOUNTIFUL BASKET FOOD SHELF CONFIDENTIALITY POLICY & AGREEMENT

Confidentiality is basic to the maintenance of professional ethics and community respect. Clients act in good faith, expecting their circumstances and personal matters to remain confidential. We are obligated by law and ethics to maintain confidentiality.

The following information is presented to provide guidelines concerning confidentiality.

  1. Information and details about a client may be discussed among Bountiful Basket programs for clinical purposes only. That is, cases may be discussed in staffing, supervisory and clinical meetings in order that cases may be more appropriately managed.
  2. No identifying information about a client (name, address) should be revealed except within Bountiful Basket.
  3. Records kept on clients are used only for case management and not for general perusal. Other agencies requesting the records of a given client must obtain a release of information from the client. In no case are records automatically sent to another person or agency without first receiving this release of information from the client or legal guardian.
  4. Discussing the details of a case outside Bountiful Basket even though names and addresses are not revealed is a breach of confidentiality.
  5. Confidentiality must be maintained even when a case has been made public through the news media.
  6. Volunteers will have access to client information only as authorized by staff. All volunteers will follow the confidentiality policy as outlined.

I, the undersigned, understand and agree to the above policy, and am aware that any breach of confidentiality warrants reprimand and/or dismissal.

Name(Required)
MM slash DD slash YYYY

Bountiful Basket Food Shelf
– Chaska Location
1600 Bavaria Road
Chaska, MN.  55318

952-556-0244

Bountiful Basket Food Shelf
- Cologne Location
(at St. Bernard's Catholic School)
300 Church St. E
Cologne, MN.  55322

952-988-2802

Chaska Hours

Monday – 9:00 am – 3:30 pm

Tuesday – 9:00 am – 6:30 pm

Wednesday – 9:00 am – 3:30 pm

Thursday – 9:00 am - 12:30 pm

Friday – 9:00 am – 12:30 pm

1st & 3rd Saturday of each month 9 am – Noon

 

Cologne Hours

Thursday – 3:30 pm - 6:30 pm

Friday – 10:00 am – 2:00 pm

Donated food may be dropped off at the Bountiful Basket during all open hours.

Note: Cologne phone is answered during all Chaska & Cologne operating hours.