Contact information- Central
We greatly appreciate your assistance and commitment to promoting health, education, and friendship through
volunteering. For several reasons, we have to maintain an accurate record of all volunteers. This is an annual form where
you agree to release SAIVA, including its directors, officers, employees, and agents of all liability while participating in
any activity organized through SAIVA. This is a voluntary release for any and all future injuries or accidents. The risks
include those foreseen and unforeseen, known and unknown. This form is in effect for one year from the signing date.
I, the volunteer, desire to work as a volunteer for SAIVA and engage in the various activities. I understand that the
activities may include, but are not limited to: being transported by volunteers or other agencies, working in offices,
working in volunteer service venues, participating in educational sessions, practicing Yoga and Meditation or other
holistic health techniques, cooking and serving food and drinks, providing babysitting services, and participating in
special events and fund-raisers. I hereby freely, voluntarily, and without duress execute this Release under the following
1. I do hereby voluntarily release, waive, discharge, hold harmless, defend and indemnify SAIVA, and its
employees, officers, staff, volunteers, and agents from and against any and all claims, actions or losses for bodily
injury, property damage, wrongful death, loss of services or otherwise which may arise as a result of providing or
using transportation services provided by SAIVA volunteers or agents. By signing this release, I specifically
understand that I am giving up the right to sue SAIVA and am releasing, discharging and waiving any claim or
actions that I may have presently or which may arise in the future for the acts and conduct of the employees,
officers, staff, volunteers, and agents of SAIVA arising during the transportation.
2. I assume all risks of personal injury, including death and damage to personal property sustained during SAIVA
volunteer events, and release SAIVA, and its employees, officers, staff, volunteers, and agents from any and all
liability for any injury, death or damages, suffered whether due to negligence of SAIVA. I agree to defend,
indemnify and hold the SAIVA, and its employees, officers, staff, volunteers, and agents harmless from and
against any and all actions, suits, claims, demands, causes of action, proceedings, losses, costs, expenses
including, without limitation, all attorney fees and disbursements, damages, liability and fines or penalties, in any
way arising out of, or relating to, connected with directly or indirectly, the use of the Premises regardless of
whether there is active or passive negligence or fault on the part of SAIVA. I agree to indemnify and hold
harmless SAIVA for any costs incurred to treat me, even if an indemnitee has signed hospital documentation
promising to pay for the treatment due to my inability to sign the documentation. I understand that SAIVA does
not maintain any insurance policy covering any circumstances arising from my participation in volunteer
activities or any event related to that participation. As such, I am aware that I should review my personal
insurance coverage. I give permission to receive appropriate first aid in the event of accident or injury, and to be
transported to the hospital for needed medical care.
3. I hereby release SAIVA from any claims which might occur from the consumption of any food prepared,
originally intended and scheduled to be consumed at the designated time of various events, or where food is
removed to be consumed off premises at a later time. These liabilities will include but are not limited to any
health hazards resulting from improper or inappropriate handling, storage and display of any food items.
4. Given the diverse nature of volunteer activities undertaken, I acknowledge that my participation in the volunteer
activities may expose me to various risks of damage to property, or physical injury, sickness or death. I further
acknowledge that SAIVA is not able to ensure my complete safety while I am participating in any such activity
and I freely accept and fully assume all liability for such risks, damages, hazards, losses, injury, expense, or
inconvenience that may arise during my participation in any activity.
5. I understand that yoga includes physical movements as well as an opportunity for relaxation, stress re-education
and relief of muscular tension. As is the case with any physical activity, the risk of injury, even serious or
disabling, is always present and cannot be entirely eliminated. If I experience any pain or discomfort, I will listen
to my body, adjust the posture, and ask for support from the teacher. I affirm that I alone am responsible to decide
whether to practice yoga or any other physical activity organized by SAIVA.
6. I do hereby give SAIVA the irrevocable right to use my name, picture, portrait, or photograph in all forms and
media and in all manners, including composite, for advertising, for publication or any other lawful purposes, and I
waive any right to inspect or approve the finished product, including written copy, which may be created.
7. By signing this document, I verify that I have understood this waiver, and that I have had the opportunity to ask
for clarification of all and any of its parts. I have also had the opportunity to receive translation of this waiver if I
do not fully understand it in English.
Emergency Contact Name
Emergency Contact Email
Emergency Contact Phone Number
As a volunteer organization, we encourage family participation. Please indicate if you are able to get involved:
Our Maa- Dada program (intergenerational volunteering) is one of our most popular and well received programs in the community. Please state your place of work and if organizing SAIVA to come volunteer with the organization would be possible.
My family and I understand and agree to the liability agreement above and will give dues on site
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