PLEASE READ CAREFULLY!

THIS IS A LEGAL DOCUMENT WHICH AFFECTS YOUR LEGAL RIGHTS!

 

RELEASE AND WAIVER OF LIABILITY

 

 

THIS RELEASE AND WAIVER OF LIABILITY (the “Release”) executed on this

 

___________ day of _____________________________________,   20_________,

 

by _____________________________________________________, a minor child (the “Volunteer”)

 

and ____________________________________________________, the parent having legal custody and/or the legal guardian of the Volunteer (the “Guardian”)

 

in favor of DANVILLE-PITTSYLVANIA COUNTY HABITAT FOR HUMANITY, INC, a Virginia nonprofit corporation, its directors, officers, employees, and agents (collectively, “Habitat”).

 

The Volunteer and Guardian desire that the Volunteer work as a volunteer for Habitat and engage in the activities related to being a volunteer.  The Volunteer and the Guardian understand that the activities may include constructing and rehabilitating residential buildings, working in the Habitat offices, and living in housing provided for volunteers of Habitat. 

 

The Volunteer and Guardian do hereby freely, voluntarily, and without duress execute this Release under the following terms:

 

1.   Waiver and Release.  Volunteer and Guardian make this release for the Volunteer as well as for his/her heirs, executors, administrators, and assigns.  Volunteer and Guardian do hereby release and forever discharge and hold harmless Habitat and its successors and assigns from any and all liability, claims, and demands of whatever kind or nature, either in law or in equity, which arise or may hereafter arise from Volunteer’s work for Habitat.

 

      Volunteer and Guardian understand and acknowledge that this Release discharges Habitat from any liability or claim that the Volunteer or Guardian may have against Habitat with respect to any bodily injury, personal injury, illness, death, or property damage that may result from Volunteer’s work for Habitat, whether caused by the negligence of Habitat or its officers, directors, employees, or agents or otherwise.  Volunteer and Guardian agree to release Habitat from any suits for contribution and/or indemnity and release Habitat for any and all past, present, or future actions as a result of any personal injury, death, or damage to property.  Volunteer and Guardian  also understand that Habitat 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.

 

2.    Medical Treatment.   Volunteer and Guardian  do hereby release and forever discharge Habitat from any claim whatsoever which arises or may hereafter arise on account of any first aid, treatment, or service rendered in connection with the Volunteer’s work for Habitat or with the decision by any representative or agent of Habitat to exercise the power to consent to medical or dental treatment as such power may be granted and authorized in the Parental Authorization for Treatment of a Minor Child.

3.   Assumption of the Risk.  The Volunteer and Guardian understand that the work for Habitat may include activities that may be hazardous to the Volunteer, including, but not limited to, construction, loading and unloading, and transportation to and from the work sites.   Volunteer and Guardian hereby expressly and specifically assume the risk of injury or harm in these activities and release Habitat from all liability for injury, illness, death, or property damage resulting from the activities of the Volunteer’s work for Habitat.

 

4.   Insurance.  The Volunteer and Guardian understand that, except as otherwise agreed to by Habitat in writing, Habitat does not carry or maintain health, medical, or disability insurance coverage for any Volunteer.

 

EACH VOLUNTEER IS EXPECTED AND ENCOURAGED TO OBTAIN HIS OR HER MEDICAL OR HEALTH INSURANCE COVERAGE.

 

5.   Photographic Release.  Volunteer and Guardian do hereby grant and convey unto Habitat all right, title, and interest in any and all photographic images and video or audio recording made by Habitat during the Volunteer’s work for  Habitat, including, but not limited to, any royalties, proceeds, or other benefits, derived from such photographs or recordings.

 

6.   Work Rules.  Volunteer and Guardian understand and agree to follow Habitat work rules and safe practice policies, which were adopted, in part, to create and provide for safe worksites and working conditions.

 

7.   Other.  Volunteer and Guardian expressly agree that this Release is intended to be as broad and inclusive as permitted by the laws of the State of Virginia, and that this Release shall be governed by and interpreted in accordance with the laws of the State of Virginia.  Volunteer and Guardian agree that in the event that any clause or provision of this Release shall be held to be invalid by any court of competent jurisdiction, the invalidity of such clause or provision shall not otherwise affect the remaining provisions of this Release which shall continue to be enforceable.

 

     IN WITNESS WHEREOF, Volunteer has executed this Release as of the day and year first above written.

 

Witness:                                                                                Volunteer:

 

__________________________                         _________________________________________

                                               

Witness:                                                                                Parent or Guardian:

 

__________________________                          _____________________________

 

Witness:                                                                                Parent or Guardian:

 

_________________________                        _______________________________

 

Address: ___________________________________________________________________

 

                                                                                                

Phone: (H) _____________________

                                                                              

(W) __________________________

 

 

 

 

 

 

 

PARENTAL AUTHORIZATION FOR TREATMENT

OF A MINOR CHILD

 

 

 

I am the parent or legal guardian of

 

_____________________________________

 

who has volunteered to work on a project for Danville-Pittsylvania County

 

Habitat for Humanity.  I hereby authorize any representative of Danville-

 

Pittsylvania County Habitat for Humanity to seek, obtain, or provide

 

medical treatment for my child in the event my child is injured while on a

 

work project or traveling to or from the said project.

 

 

 

 

 

 

_________________________________________________________

Signature of Parent or Legal Guardian

 

 

 

_________________________________

Date

 

 

 

ADULT VOLUNTEER FORM

 

PLEASE READ CAREFULLY!

THIS IS A LEGAL DOCUMENT WHICH AFFECTS YOUR LEGAL RIGHTS!

 

RELEASE AND WAIVER OF LIABILITY

 

 

THIS RELEASE AND WAIVER OF LIABILITY (the “Release”) executed on this

 

___________ day of _____________________________________,   20_________,

 

by _____________________________________________________ (the “Volunteer”)

 

in favor of DANVILLE-PITTSYLVANIA COUNTY HABITAT FOR HUMANITY, INC, a Virginia nonprofit corporation, its directors, officers, employees, and agents (collectively, “Habitat”).

 

The Volunteer desires to work as a volunteer for Habitat and engage in the activities related to being a volunteer.  The Volunteer understands that the activities may include constructing and rehabilitating residential buildings, working in the Habitat offices, and living in housing provided for volunteers of Habitat. 

 

 

 

The Volunteer does hereby freely, voluntarily, and without duress execute this Release under the following terms:

 

 

1.   Waiver and Release.  Volunteer makes this release for himself/herself as well as for his/her heirs, executors, administrators, and assigns.  Volunteer does hereby release and forever discharge and hold harmless Habitat and its successors and assigns from any and all liability, claims, and demands of whatever kind or nature, either in law or in equity, which arise or may hereafter arise from Volunteer’s work for Habitat.

 

      Volunteer understands and acknowledges that this Release discharges Habitat from any liability or claim that the Volunteer may have against Habitat with respect to any bodily injury, personal injury, illness, death, or property damage that may result from Volunteer’s work for Habitat, whether caused by the negligence of Habitat or its officers, directors, employees, or agents or otherwise.  Volunteer agrees to release Habitat from any suits for contribution and/or indemnity and releases Habitat for any and all past, present, or future actions as a result of any personal injury, death, or damage to property.  Volunteer also understands that, except as otherwise agreed to by Habitat in writing, Habitat 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.

 

 

2.    Medical Treatment.   Except as otherwise agreed to by Habitat in writing, Volunteer does hereby release and forever discharge Habitat from any claim whatsoever which arises or may hereafter arise on account of any first aid, treatment, or service rendered in connection with the Volunteer’s work for Habitat.

 

 

 

3.   Assumption of the Risk.  The Volunteer understands that the work for Habitat may include activities that may be hazardous to the Volunteer, including, but not limited to, construction, loading and unloading, and transportation to and from the work sites.  In connection thereto, Volunteer recognizes and understands that activities at Habitat may, in some situations, involve inherently dangerous activities.

 

     Volunteer hereby expressly and specifically assumes the risk of injury or harm in these activities and releases Habitat from all liability for injury, illness, death, or property damage resulting from the activities of the Volunteer’s work for Habitat.

 

 

4.   Insurance.  The Volunteer understands that, except as otherwise agreed to by Habitat in writing, Habitat does not carry or maintain health, medical, or disability insurance coverage for any Volunteer.

 

EACH VOLUNTEER IS EXPECTED AND ENCOURAGED TO OBTAIN HIS OR HER MEDICAL OR HEALTH INSURANCE COVERAGE.

 

 

5.   Photographic Release.  Volunteer does hereby grant and convey unto Habitat all right, title, and interest in any and all photographic images and video or audio recording made by Habitat during the Volunteer’s work for  Habitat, including, but not limited to, any royalties, proceeds, or other benefits, derived from such photographs or recordings.

 

 

6.   Work Rules.  Volunteer understands and agrees to follow Habitat work rules and safe practice policies, which were adopted, in part, to create and provide for safe worksites and working conditions.

 

 

7.   Other.  Volunteer expressly agrees that this Release is intended to be as broad and inclusive as permitted by the laws of the State of Virginia, and that this Release shall be governed by and interpreted in accordance with the laws of the State of Virginia.  Volunteer agrees that in the event that any clause or provision of this Release shall be held to be invalid by any court of competent jurisdiction, the invalidity of such clause or provision shall not otherwise affect the remaining provisions of this Release which shall continue to be enforceable.

 

 

 

     IN WITNESS WHEREOF, Volunteer has executed this Release as of the day and year first above written.

 

Witness:                                                                                Volunteer:

 

__________________________                          _____________________________

 

Address:

__________________________________________________________________   

 

Email Address____________________________________  

 

Phone: (H) ______________________________

                                                                     

(W) ______________________________