DeWitt Referral Center: Volunteer Application & Waiver
Volunteer Application & Waiver
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Email *
First Name *
Last Name *
Address *
City *
State *
Zip Code *
Phone *
Emergency Contact *
Emergency Phone Number *
Allergies *
Please tell us why you wold like to volunteer at the Referral Center? *
Do you have any specific skills or experiences (e.g. retail, thrift store, food bank, etc,) *
I understand the importance of confidentiality of clients and customers. Therefore, I will not discuss any information I hear or see with anyone outside of the DeWitt Referral Center staff.  *
Required

Volunteer Waiver of Liability Form

This release and waiver of liability (the “Release”) executed by me (“Volunteer”) releases DeWitt Referral Center, (“Nonprofit”), a nonprofit corporation organized and existing under the laws of the State of Iowa and each of its directors, officers, employees, and agents. The Volunteer desires to provide volunteer services for Nonprofit and engage in activities related to serving as a volunteer. 

Volunteer understands that the scope of Volunteer’s relationship with Nonprofit is limited to a volunteer position and that no compensation is expected in return for services provided by Volunteer; that Nonprofit will not provide any benefits traditionally associated with employment to Volunteer; and that Volunteer is responsible for his/her own insurance coverage in the event of personal injury or illness as a result of Volunteer’s services to Nonprofit. 

Waiver and Release: I, the Volunteer, release and forever discharge and hold harmless Nonprofit and its successors and assigns from any and all liability, claims, and demands of whatever kind of nature, either law or equity, which arise or may hereafter arise from the service I provide to Nonprofit. I understand and acknowledge that this Release discharges Nonprofit from any liability or claim that I may have against Nonprofit with respect to bodily injury, personal injury, illness, death or property damage that may result from the service I provide to Nonprofit or occurring while I am providing volunteer services. 

Insurance: Further, I understand that Nonprofit 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. I expressively waive any such claim for compensation or liability on the part of Nonprofit beyond what may be offered freely by Nonprofit in the event of injury or medical expenses incurred by me. 

Medical Treatment: I hereby Release and forever discharge Nonprofit from any claim whatsoever which arises or may hereafter arise on account of any first-aid treatment or other medical services rendered in connection with an emergency during my tenure as a volunteer with Nonprofit.

Assumption of Risk: I understand that the services I provide to Nonprofit may include activities that may be hazardous to me including, but not limited to lifting up to 50 pounds. As a volunteer, I hereby expressively assume risk of injury or harm from these activities and Release Nonprofit from all liability. 

Photographic Release: I grant and convey to Nonprofit all right, title and interests in any and all photographs, images, video, or audio recordings of me or my likeness or voice made by Nonprofit in connection with my providing volunteer services to Nonprofit. 

Other: As a volunteer, I expressively agree that this Release is intended to be broad and inclusive as permitted by the laws of the State of Iowa and that this Release shall be governed by and interpreted in accordance with the laws of the State of Iowa. I agree that in the event that any clause or provision of this release is deemed invalid, the enforceability of the remaining provisions of this Release shall not be affected. 

By providing my electronic signature below, I express my understanding and intent to enter into this Release and Waiver of Liability willingly and voluntarily.

*
Required

If you agree to the above, enter your first and last name. Please note that this serves as your signature.  If you are a minor, please have your parent/guardian sign. Parent/guardian please include child's name and your name on the line below.


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A copy of your responses will be emailed to the address you provided.
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