I, the undersigned, wish to volunteer my services to assist with disaster relief efforts through United Way of Palm Beach County (to be referred to as "UWPBC"), a not for profit Florida corporation.  In consideration for allowing me to participate in UWPBC, and in consideration of UWPBC's locating, arranging, coordinating and/or making available this volunteer opportunity, I hereby agree and release UWPBC as follows:

 

1.      I acknowledge and agree that the nature of the volunteer services, will be performed by me today as a UWPBC volunteer, will involve (a) physical activity (including without limitation work with heavy tools and materials), (b) contact with unidentified unfamiliar persons, (c) travel to and from various unspecified locations, and (d) other potential risk of injury.  Notwithstanding the preceding sentence, I willingly and freely agree to volunteer and hereby assume any and all risk in connection with my volunteer efforts or participation, including without limitation risk of any accident, injury or illness, or injury to person or property which I may sustain in connection with my participation as a UWPBC volunteer or in any UWPBC project or activity. In addition to the foregoing, I will only participate in UWPBC activities and projects that I am physically capable of participation without risk of injury to myself.  I serve as a volunteer for this specific disaster relief effort knowing that the work I volunteer for and tasks I will provide will be done in an area which has experienced a disaster and therefore I fully understand and accept full responsibility of knowing that I am volunteering in an area which will have hazards and recognize that such hazards might result in harm to me.

2.   I hereby acknowledge that UWPBC is an organization involved in assisting organizations and associations, which may from time to time be involved with disaster relief efforts and related matters.  I hereby confirm, represent and warrant that I have never been convicted of a violent crime, child abuse, or neglect, child pornography, child abduction, kidnapping, rape or sexual offense, or any other violation of law, nor have I ever been ordered by a court to receive psychiatric or psychological treatment in connection herewith.

3.     I hereby release UWPBC and its directors, officers, partners, agents, employees, successors, assigns, licensees, sponsors, donors, representatives, guests and affiliates from, and covenant not to sue for, any and all claims and causes of action, whether known or unknown, arising out of, based upon or relating to my participation as a UWPBC volunteer or in any UWPBC related activity or project, including without limitation, any negligence of UWPBC, its officers, directors, partners, employees, agents, successors, assigns, licensees, sponsors, donors, representatives, guests, and affiliates.  Furthermore, to the extent I use my own vehicle for transportation or other purposes in connection with a UWPBC project or activity, I hereby represent and warrant that I am, and the vehicle is, fully insured to the extent required by law.

4.     I hereby agree to indemnify and hold UWPBC, its directors, officers, partners, agents, employees, successors, assigns, licensees, sponsors, donors, representatives, guests and affiliates harmless against any and all liabilities claims, actions, damages, losses, judgments, fines, deficiencies, injuries, suits and proceedings at law or in equity, costs, or any other expense, fee or charge of any character or nature through all levels of appeal and any amounts paid in settlement of the foregoing which may be imposed upon, incurred or threatened by or upon UWPBC (or any related party as referenced above) or any of its property in respect to, or arising out of, my participation as a UWPBC volunteer or in any UWPBC related project or activity.

5.   I further irrevocably grant to UWPBC, its assigns, and successors, my consent and full right to: use my name, photograph, likeness, image, voice and biography in any and all media, publications, advertising, and publicity, in connection with my participation with UWPBC and any UWPBC related activity or project.

6.   This release shall insure to the benefit of UWPBC and its successors, licenses, agents, employees, affiliatiates and assigns. The laws of the State of Florida shall govern this release. 

 

Confidentiality Statement

I hereby agree to regard all information received as a part of my volunteer work with United Way of Palm Beach County as confidential.

I understand that United Way of Beach County respects its agencies, staff, and volunteers’ rights with regard to privacy of any information that I may hear or see while volunteering, and I agree to respect those rights during the performance of my volunteer duties and to keep them as confidential while outside of United Way of Palm Beach County.

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NO GOODS OR SERVICES HAVE BEEN GIVEN IN RETURN FOR THIS CONTRIBUTION, FL Solicitation Registration Number: CH802 "A copy of the official registration and financial information may be obtained from the Division of Consumer Services by calling toll-free (800-435-7352) within the state. Registration does not imply endorsement, approval, or recommendation by the state." United Way of Palm Beach County receives 100% of each contribution.