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VOLUNTEER WAIVER

I hereby release, indemnify, and hold harmless Meals on Wheels of Boulder, Inc., its officers, directors, board members, employees, sponsors or their representatives, or their successors from all claims and demands of whatever kind or nature, either in law or in equity, which may arise in conjunction with my activities with Meals on Wheels of Boulder, Inc.

I understand and acknowledge that my participation as a volunteer at MOWB may expose me to risk of personal injury or death and loss or damage to personal property. I hereby agree to release the individual members of Meals on Wheels of Boulder, Inc. staff, officers, employees, members, sponsors, volunteers and Board of Directors of the organization from any liability or claim that I may have against Meals on Wheels of Boulder, Inc. with respect to any bodily injury, personal injury, illness, death or property damage that may result from my activities with Meals on Wheels of Boulder, Inc., whether or not caused by the negligence of Meals on Wheels of Boulder, Inc. or its officers, directors, employees, or agents or otherwise. I agree to hold harmless the above persons and organization against all damages, claims, demands, rights and causes of action of whatever kind and nature, based upon injuries or property damages to or death of, (including without limitation any employee, invitee, or other person) arising out of my volunteer work with MOWB on or off MOWB property. I also understand that Meals on Wheels of Boulder, Inc. 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.

As a Meals on Wheels of Boulder, Inc. (MOWB) volunteer, you are limited to disseminating information that is to the benefit of MOWB. MOWB volunteers are expected to represent MOWB in a professional manner in accordance with the organization’s policies and procedures. Furthermore, volunteers are expressly prohibited from interacting with clients in a way that is inconsistent with MOWB’s mission and values. Volunteers shall treat all information as confidential, including, but not limited to:

  1. Names and addresses of clients, current or past.
  2. Information related to the social and economic conditions or circumstances concerning any individual, including wage or income information.
  3. Medical, psychological, or social evaluation, including diagnosis or history of disease or disability of any kind.

I have read the above statement concerning confidentiality and understand its significance in my work. I will follow its instructions and intent and not share information about clients outside the agency. I have read and voluntarily sign this release and waiver of liability and indemnity agreement, and further agree that no oral representation, statement, or inducement apart from the foregoing written agreement have been made.

I give my full permission for such first aid as deemed necessary to be provided to me on the premises where I may be acting as a volunteer or prior to transport to a hospital for further treatment in the case of emergency while volunteering with MOWB.

 

Parental Approval / Signature Required for Minors

Date: November 27, 2021

First Volunteer's Name

First Name*

Last Name*
First Volunteer's Date of Birth*
I certify that I am 18 years of age or older
First Volunteer's Information
I give my full permission for the use of my name, photos, and video images in promotional materials, which includes social media and press stories.*
Yes
No
First Volunteer's Signature*
Second Volunteer's Name

First Name*

Last Name*
Second Volunteer's Date of Birth*
Second Volunteer's Information
I give my full permission for the use of my name, photos, and video images in promotional materials, which includes social media and press stories.*
Yes
No
Third Volunteer's Name

First Name*

Last Name*
Third Volunteer's Date of Birth*
Third Volunteer's Information
I give my full permission for the use of my name, photos, and video images in promotional materials, which includes social media and press stories.*
Yes
No
Fourth Volunteer's Name

First Name*

Last Name*
Fourth Volunteer's Date of Birth*
Fourth Volunteer's Information
I give my full permission for the use of my name, photos, and video images in promotional materials, which includes social media and press stories.*
Yes
No
Fifth Volunteer's Name

First Name*

Last Name*
Fifth Volunteer's Date of Birth*
Fifth Volunteer's Information
I give my full permission for the use of my name, photos, and video images in promotional materials, which includes social media and press stories.*
Yes
No
Sixth Volunteer's Name

First Name*

Last Name*
Sixth Volunteer's Date of Birth*
Sixth Volunteer's Information
I give my full permission for the use of my name, photos, and video images in promotional materials, which includes social media and press stories.*
Yes
No
Seventh Volunteer's Name

First Name*

Last Name*
Seventh Volunteer's Date of Birth*
Seventh Volunteer's Information
I give my full permission for the use of my name, photos, and video images in promotional materials, which includes social media and press stories.*
Yes
No
Eighth Volunteer's Name

First Name*

Last Name*
Eighth Volunteer's Date of Birth*
Eighth Volunteer's Information
I give my full permission for the use of my name, photos, and video images in promotional materials, which includes social media and press stories.*
Yes
No
Ninth Volunteer's Name

First Name*

Last Name*
Ninth Volunteer's Date of Birth*
Ninth Volunteer's Information
I give my full permission for the use of my name, photos, and video images in promotional materials, which includes social media and press stories.*
Yes
No
Tenth Volunteer's Name

First Name*

Last Name*
Tenth Volunteer's Date of Birth*
Tenth Volunteer's Information
I give my full permission for the use of my name, photos, and video images in promotional materials, which includes social media and press stories.*
Yes
No
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Information
I give my full permission for the use of my name, photos, and video images in promotional materials, which includes social media and press stories.*
Yes
No
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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