CIOGC & ICNA Relief-Volunteer Sign up Sheet
Asalamu Alaikum, Greetings of Peace,

At ICNA Relief, we credit as much as 80% of our programs and success to volunteers. Jazakum Allah Khair! Thank you for choosing ICNA Relief!

All potential volunteers and parents of under-aged volunteers are required to provide the following information.
We'll find you a great fit!

Where necessary, candidates will be interviewed before a final selection is made.

For questions, please contact chicago@icnarelief.org: (844) 414-4862. We look forward to hearing from you.

Sincerely,
Dr. Saima Azfar
Director, ICNA Relief Chicago
Glendale Heights, IL 60139
www.icnarelief.org
Email address *
United We Stand: Our Home, Our Responsibility with ICNA Relief in Chicago
Liability Waiver and Release of Information
Release of Liability and COVID-19 Related Information
1. I, the Volunteer, release and forever discharge and hold harmless ICNA Relief and its successors
from any and all liability, claims, and demands of whatever kind of nature, either in law or in equity,
which arise or may hereafter arise from the volunteer services I provide to ICNA Relief. I
understand and acknowledge that this Release discharges ICNA Relief from any liability or claim
that I may have against ICNA Relief with respect to bodily injury, personal injury, illness, death,
dismemberment, or property damage that may result from the volunteer services I provide to ICNA
Relief or occurring while I am providing volunteer services.
2. I agree not to directly or indirectly seek, receive or accept any payment, reimbursement or other
compensation whatsoever for service as a volunteer or for any other goods or services provided by
ICNA Relief. This means, among other things, that I will not accept payments from a community
member, patient, third party payer or any other source. I understand that I will be serving as an
unpaid volunteer with ICNA Relief, that I am not an agent or employee of ICNA Relief, and that I
have no power or authority to bind or obligate ICNA Relief.
3. Insurance: Further I understand that ICNA Relief does not assume any responsibility for or
obligation to provide me with financial or other assistance, including but not limited to medical,
health, or disability benefits or insurance.
4. As a volunteer, I hereby expressly assume risk of injury, harm, or loss of property from any
activities performed while volunteering and release ICNA Relief from all liability.
5. As a volunteer, I hereby expressly assume risk of getting sick and/or infected with the Corona Virus
from any activities performed while volunteering and release ICNA Relief from all liability.
6. Photographic Release: I grant and convey to ICNA Relief all right, title, and interests in any and all
photographs, images, video, or audio recordings of me or my likeness or voice made by ICNA
Relief in connection with my providing volunteer services to ICNA Relief.
7. I am not experiencing at this time: fever, sore throat, cough, stuffy nose, or any other type of
symptoms related to COVID-19.
8. I have not been in contact with anyone exhibiting any such symptoms, as mentioned in clause 7
above, within the last 14 days.
9. I have not traveled to any of the countries considered to be Level 1, 2, or 3 within the last month.
Nor have I been in contact with anyone who has traveled to these countries.
Print Name of Volunteer & Date* *
Your answer
Print Name of Parent/Guardian ( For Volunteer under 18 Years of age)
Your answer
Signature of Volunteer (18 years or older)/Signature of Parents / Guardian & Date *
Your answer
Select Area of Interest *
(Choose all that apply)
Required
Indicate Availability - Days and Times: *
Required
City, & Zipcode *
Your answer
Cell Phone Number: *
Your answer
Please Join TASKFORCE Whatsapp Group by Clicking The Link Below:
The Best Way to Reach Me Is: *
Required
Prior Volunteering Experience, Including Any With ICNA Relief or any other organization.
(If no prior experience, mention "First Timer')
Your answer
List one or more References *
Provide Name, Cell, Email, and Organization
Your answer
Join the ICNA Relief Chicago e-news? *
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