Student or Volunteer/Observer
Opportunity Application

Requirements:

• Applicants must be enrolled or planning/preparing to enroll in a physical, occupational or speech therapist undergraduate or graduate program or an educational program that is related to a profession that serves children with delays or disabilities, such as a special education teacher, psychologist or
  pediatrician.
• Applicants must be HUMBLE, energetic, friendly, easily directed, and eager to learn about pediatric therapy.
• Applicants should feel confident their ability to be a good communicator and a self starter.
• Hours are based on attendance of the children receiving services. We will do our best to accommodate requests for specific days and times within the schedule of the therapist offering the Volunteer/Observer or clinical internship opportunity.
• Students Volunteers/Observers must bring their own log forms to document their time before leaving the building or before completion of the agreed upon total hours. The Volunteer/Observer is expected to fill in the hours and ensure it is signed by the designated therapist.  We cannot and will not sign forms to confirm your hours weeks after completion of the experience.
• To obtain Volunteer/Observer observation hours, the Volunteer/Observer is also required to volunteer services to the clinic. This is to be offered at a 2:1 ratio. For every 2 hours of observation, 1 hour of volunteering must be completed. Example of volunteer duties are: copying and laminating or wiping down toys and mats. Most volunteer hours will be able to be completed within view of therapy in progress and these hours can be included in your total observation hours to be documented.

Recognizing the importance of preserving the integrity of the therapist/patient relationship, and in acknowledgement of the Health Insurance Portability and Accountability Act (Public Law 104-191), all students completing the form below must promise to honor the confidentiality of each client whose care and treatment they are permitted to observe and/or contribute to with the therapist as part of their participation in the opportunity. All students and/or Volunteer/Observers must agree to not reveal to any person the names or any other identifying information of the individual clients whose care and treatment was observed and/or contributed to as a result of participation in the program. Students and/or Volunteer/Observers will not discuss with any other person any details of the internship or observation experience that might cause the client’s identity to be revealed.

Completion of the form below will additonally serve as consent for Bautz Developmental Intervention, Inc. (DBA BDI Playhouse Children’s Therapy) and to its employees, agents and assigns the right to photograph the student or Volunteer/Observer and to utilize the photo/video and/or other digital reproduction of themselves for publication processes, whether electronic, print, digital or electronic publishing via the internet for the purpose of marketing/advertising/promotion of services/purpose of instruction/documentation of patient condition, etc.

By completion and submission of the form below, the Student and/or Volunteer/Observer acknowledges that their presence on the premises of Bautz Developmental Intervention, Inc. (BDI Playhouse) and/or their presence at any other setting where BDI services are provided may, even under ideal conditions, including the proper use of materials and adherence to safety procedures, pose a risk of personal injury. Participants may be removed from the opportunity on a temporary or permanent basis if the individual refuses or is unable to follow safety rules, wear or utilize assigned personal protective equipment, or perform activities as directed.

Prior to participation, the participant must notify the assigned supervising BDI faculty member of any allergies or other physical, mental, or emotional condition that might limit their ability to safely participate in activities at the facility to which they are assigned.

The participant must fully recognize that their presence is voluntary, and that they have made the decision to participate despite the possible dangers and risks, specific and unforeseen.

The participant’s completion and submission of the form below indicates an understanding that neither Bautz Developmental Intervention, Inc., it’s employees, nor the student and/or Volunteer/Observer, shall earn or receive any compensation in connection with assigned. 

The participant completing and submitting the form below therefore agrees to indemnify, release, defend, and hold harmless the officers and employees of Bautz Developmental Intervention, Inc., its administration, faculty, staff and agents from any and all liability, claims and actions that may arise from injury or harm to the participant, from the participant’s death, or damage to the participant’s property while participating in this opportunity with Bautz Developmental Intervention, Inc. It is further understood by the individual competing this form, that this release covers liability, claims and actions caused entirely or in part by any acts or failures to act by Bautz Developmental Intervention, Inc., its governing officers, employees, agents and students, including but not limited to negligence, mistake or, failure to supervise by Bautz Developmental Intervention, Inc., its governing officers, employees, agents and students. The participant also understands that this release means they are giving up, including but not limited to, all rights to take any legal action against Bautz Developmental Intervention, Inc., its governing officers, employees, agents and students for injuries, damages or losses the participant may incur. Signature below also releases and binds the participant’s heirs, executors, administrators, and assigns.