RELEASE AND WAIVER OF LIABILITY
(For individuals under the age of 18, a Parent/Guardian signature is required)
(Read this document carefully before signing; it is a legal document that affects your legal rights.)
This Release and Waiver of Liability (the “Release”) is executed on this ___ day of _______________, 20___, by ________________________ (the “Volunteer”) in favor of The Center for Family Resources, a Georgia nonprofit corporation, and its directors, officers, employees, volunteers, and agents (collectively, “CFR”).
The Volunteer desires to serve as a volunteer for CFR and engage in activities related to CFR’s goal of assisting individuals and families to attain self-sufficiency (the "Activities"). In consideration of CFR’s allowing the Volunteer to engage in the Activities, the Volunteer, being at least 18 years of age, hereby freely, voluntarily, and without duress, agrees as follows:
Release and Waiver
The Volunteer understands that the Activities may include intense physical labor, strenuous activity, traveling to work sites or other tasks which entail a risk of physical injury. Volunteer does hereby release and forever discharge and hold harmless CFR and its successors and assigns from any and all liability, claims, and demands of whatever kind or nature, either in law or in equity, which arise or may hereafter arise from Volunteer’s participation in the Activities. Volunteer understands that this Release discharges CFR from any liability or claim that the Volunteer may have against CFR with respect to any bodily injury, personal injury, illness, death, property damage or other harm that may result from Volunteer’s participation in the Activities, whether caused by the negligence of CFR or its officers, directors, employees, or agents or otherwise. Volunteer also understands that CFR does not assume any responsibility for or obligation to provide financial assistance or other assistance, including but not limited to medical, health, or disability insurance in the event of injury or illness.
Medical Treatment
Volunteer does hereby release and forever discharge CFR from any claim whatsoever which arises or may hereafter arise on account of any first aid, treatment, or service rendered in connection with the Volunteer’s Activities with CFR.
Insurance
Volunteer understands that, except as otherwise agreed to by CFR in writing; CFR does not carry or maintain health, medical, or disability insurance coverage for any Volunteer. Each Volunteer is expected and encouraged to obtain his or her own medical or health insurance coverage.
Photographic Release
Volunteer does hereby grant and convey unto CFR all right, title, and interest in any and all photographic images and video or audio recordings made by CFR during the Volunteer’s participation in the Activities, including, but not limited to, any royalties, proceeds, or other benefits derived from such photographs or recordings.
Georgia Law
Volunteer expressly agrees that this Release is intended to be as broad and inclusive as permitted by the laws of the State of Georgia and that this Release shall be governed by and interpreted in accordance with the laws of the State of Georgia. Volunteer agrees that in the event that any clause or provision of this Release shall be held to be invalid by any court of competent jurisdiction, the invalidity of such clause or provision shall not otherwise affect the remaining provisions of this Release which shall continue to be enforceable.
Statement of Confidentiality
This is a statement of my understanding of the importance of confidentiality in all areas of client information. I understand that any breach of confidentiality is grounds for termination of my volunteer assignment.
1) Clients, employees and volunteers have a right to the protection of confidential information about themselves. Only in exceptional situations, (e.g., a court subpoena) or where it is necessary to protect the client or others may the Organization supersede this right.
2) Clients are usually the primary source of information about themselves. The Organization must obtain written consent before sharing information with other organizations.
3) Even within the organization, employees and volunteers must keep client, employee and volunteer entrusted confidences from disclosure to any staff member or volunteer who is not essential for providing services to the client.
4) Upon receiving a confidential report from another organization or individual, The Center for Family Resources does not have the right to divulge this information to a third party without securing written permission from the client, volunteer or employee.
5) The use of a case record for research or training is not a breach of confidentiality, provided the employee has effectively disguised the identity of the client and their family in the exercise materials.
6) At times photographs and human-interest stories are needed to publicize and promote The Center for Family Resources. The clients must first sign the appropriate form giving their permission.
Examples of Breach of Confidentiality (not all-inclusive):
a. Discussing a client’s case plan or situation when it is not essential for providing services; b. Naming a client and their case plan or situation in a public setting; c. Speaking of a client within hearing of other clients; d. Reading any client’s file when not essential to providing services; e. Asking any The Center for Family Resources staff or volunteer about the case plan or situation of a client known personally to me; f. Reading any correspondence or information relating to a client and/or discussing that information with others when not related to providing services to the client
I have read in full and understand the above release and waiver of liability form and statement of confidentiality. In addition, I understand that any breach of confidentiality is grounds for immediate termination of your volunteer assignment.
