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Waiver
Who is this registration for?
Please provide a name and email address for a parent or guardian, they will need to sign off for you.
Parent/guardian first name:
Parent/guardian email:
I, __________________________, have freely and voluntarily chosen to provide services ("Services") for The United Methodist Children's Home of the North Georgia Conference, Inc. d/b/a Wellroot Family Services ("Wellroot"). I understand and agree that, while providing Services as a volunteer for Wellroot, there are certain risks (some of which I may not fully recognize) and that injuries, death, property damage or other harm could occur to me during or resulting from the provision of the Services. I understand that, because of the potential danger in providing such Services, Wellroot is unwilling to allow me to provide Services unless I sign this Volunteer Release, Waiver and Hold Harmless Agreement. I therefore covenant and agree, on behalf of myself and my heirs, assigns, and any other person claiming by, under or through me, as follows:
1. I accept and voluntarily assume all risks of any injuries, damages or harm which arise during or result from my provision of the Services, including any risk associated with any special medical needs or conditions that I may have, whether or not these risks are caused in whole or in part by the negligence or other fault of Wellroot or its directors, officers, employees, agents or insurers (the "Released Parties").
2. I waive all claims against and hold harmless any and all of the Released Parties for any injuries, damages, expenses, liabilities, losses or claims arising during or resulting from my provision of the Services, whether known or unknown, EXPRESSLY INCLUDING, BUT NOT LIMITED TO ANY INJURY, HARM, DEATH, OR OTHER DAMAGE ARISING OUT OF OR RELATED IN ANY WAY TO ANY ACTIVE OR PASSIVE NEGLIGENCE OF THE RELEASED PARTIES OR ANY OTHER PERSON OR ENTITY, AND FOREVER RELEASE AND DISCHARGE THE RELEASED PARTIES FROM ALL SUCH CLAIMS.
3. I release and forever discharge the Released Parties from any claim whatsoever which arises or may hereafter arise on account of any first aid, treatment, or medical service rendered in connection with my provision of Services.
4. I agree to hold harmless and indemnify the Released Parties from and against all liabilities, obligations, damages, losses, claims, demands, recoveries, settlements, deficiencies, costs or expenses (including reasonable attorneys' fees) for any injury and/or death to any person or damage to any property arising, or alleged to have arisen out of any reckless or intentional act or failure to act on my part or arising from any untruthful information that I may have provided to Wellroot.
5. I understand that confidentiality concerning information pertaining to Wellroot is important and agree to maintain as confidential information or knowledge gained through my volunteer Services. Generally speaking, all information that is not publicly available or in the public domain is considered "confidential." I agree to maintain such confidentiality while working as a volunteer at Wellroot and thereafter. I further agree to protect the privacy of Wellroot residents. I will not disclose the identities of residents of Wellroot, whether through writing or photographs or some other media, without the prior written consent of Wellroot. I further understand that my violation of this confidentiality provision could result in Wellroot terminating my volunteer Services.
6. It is my express intent that this Volunteer Release, Waiver and Hold Harmless Agreement shall bind my successors, assigns, heirs, and personal representative.
7. I acknowledge and agree that this Volunteer Release, Waiver and Hold Harmless Agreement is intended to be as broad and inclusive as permitted by the laws of the State of Georgia. If any portion of this Agreement is held invalid, it is agreed that the balance of this Agreement shall continue in full legal force and effect.
8. I expressly grant and convey unto Wellroot all right, title, and interest in any and all photographic images and video or audio recordings made by Wellroot during my provision of the Services, including, but not limited to, any royalties, proceeds, or other benefits derived from such photographs or recordings. I agree that Wellroot may use such photographs or recordings with or without my name and for any lawful purpose, including but not limited to such purposes as publicity, illustration, advertising, and Web content.
9. I understand that I am not an employee, and that except as otherwise agreed to in writing, Wellroot does not carry or maintain health, medical, or disability coverage for volunteers. I understand that I am expected and encouraged to obtain adequate health or medical insurance to cover any injury, loss of income, and loss of life that I may suffer or cause while providing Services at Wellroot.
10. I agree to abide by the rules and policies adopted from time to time by Wellroot.
11. I represent that I am of lawful age and legally competent to sign this Volunteer Release, Waiver and Hold Harmless Agreement. I also understand and agree that the terms herein are contractual, and that they are not a mere recital or simply for informational purposes.
12. I acknowledge that I am signing this Volunteer Release, Waiver and Hold Harmless Agreement freely and voluntarily. I have been given a reasonable opportunity to review this Agreement and to consult with an attorney.
13. Under Georgia law, there is no liability for an injury or death of an individual entering these premises if such injury or death results from the inherent risks of contracting COVID-19. You are assuming this risk by entering these premises.
I HAVE READ THIS VOLUNTEER RELEASE, WAIVER AND HOLD HARMLESS AGREEMENT CAREFULLY AND FULLY UNDERSTAND ITS CONTENTS. NO ORAL REPRESENTATIONS, STATEMENTS OR INDUCEMENTS HAVE BEEN MADE BY ANY OF THE RELEASED PARTIES APART FROM THE FOREGOING WRITTEN AGREEMENT.
Signature of Volunteer: ______________________________________ Date: _____________________
In case of emergency, call: Name: ___________________________ Telephone: _______________
I, __________________________, have freely and voluntarily chosen to provide services ("Services") for The United Methodist Children's Home of the North Georgia Conference, Inc. d/b/a Wellroot Family Services ("Wellroot"). I understand and agree that, while providing Services as a volunteer for Wellroot, there are certain risks (some of which I may not fully recognize) and that injuries, death, property damage or other harm could occur to me during or resulting from the provision of the Services. I understand that, because of the potential danger in providing such Services, Wellroot is unwilling to allow me to provide Services unless I sign this Volunteer Release, Waiver and Hold Harmless Agreement. I therefore covenant and agree, on behalf of myself and my heirs, assigns, and any other person claiming by, under or through me, as follows:
1. I accept and voluntarily assume all risks of any injuries, damages or harm which arise during or result from my provision of the Services, including any risk associated with any special medical needs or conditions that I may have, whether or not these risks are caused in whole or in part by the negligence or other fault of Wellroot or its directors, officers, employees, agents or insurers (the "Released Parties").
2. I waive all claims against and hold harmless any and all of the Released Parties for any injuries, damages, expenses, liabilities, losses or claims arising during or resulting from my provision of the Services, whether known or unknown, EXPRESSLY INCLUDING, BUT NOT LIMITED TO ANY INJURY, HARM, DEATH, OR OTHER DAMAGE ARISING OUT OF OR RELATED IN ANY WAY TO ANY ACTIVE OR PASSIVE NEGLIGENCE OF THE RELEASED PARTIES OR ANY OTHER PERSON OR ENTITY, AND FOREVER RELEASE AND DISCHARGE THE RELEASED PARTIES FROM ALL SUCH CLAIMS.
3. I release and forever discharge the Released Parties from any claim whatsoever which arises or may hereafter arise on account of any first aid, treatment, or medical service rendered in connection with my provision of Services.
4. I agree to hold harmless and indemnify the Released Parties from and against all liabilities, obligations, damages, losses, claims, demands, recoveries, settlements, deficiencies, costs or expenses (including reasonable attorneys' fees) for any injury and/or death to any person or damage to any property arising, or alleged to have arisen out of any reckless or intentional act or failure to act on my part or arising from any untruthful information that I may have provided to Wellroot.
5. I understand that confidentiality concerning information pertaining to Wellroot is important and agree to maintain as confidential information or knowledge gained through my volunteer Services. Generally speaking, all information that is not publicly available or in the public domain is considered "confidential." I agree to maintain such confidentiality while working as a volunteer at Wellroot and thereafter. I further agree to protect the privacy of Wellroot residents. I will not disclose the identities of residents of Wellroot, whether through writing or photographs or some other media, without the prior written consent of Wellroot. I further understand that my violation of this confidentiality provision could result in Wellroot terminating my volunteer Services.
6. It is my express intent that this Volunteer Release, Waiver and Hold Harmless Agreement shall bind my successors, assigns, heirs, and personal representative.
7. I acknowledge and agree that this Volunteer Release, Waiver and Hold Harmless Agreement is intended to be as broad and inclusive as permitted by the laws of the State of Georgia. If any portion of this Agreement is held invalid, it is agreed that the balance of this Agreement shall continue in full legal force and effect.
8. I expressly grant and convey unto Wellroot all right, title, and interest in any and all photographic images and video or audio recordings made by Wellroot during my provision of the Services, including, but not limited to, any royalties, proceeds, or other benefits derived from such photographs or recordings. I agree that Wellroot may use such photographs or recordings with or without my name and for any lawful purpose, including but not limited to such purposes as publicity, illustration, advertising, and Web content.
9. I understand that I am not an employee, and that except as otherwise agreed to in writing, Wellroot does not carry or maintain health, medical, or disability coverage for volunteers. I understand that I am expected and encouraged to obtain adequate health or medical insurance to cover any injury, loss of income, and loss of life that I may suffer or cause while providing Services at Wellroot.
10. I agree to abide by the rules and policies adopted from time to time by Wellroot.
11. I represent that I am of lawful age and legally competent to sign this Volunteer Release, Waiver and Hold Harmless Agreement. I also understand and agree that the terms herein are contractual, and that they are not a mere recital or simply for informational purposes.
12. I acknowledge that I am signing this Volunteer Release, Waiver and Hold Harmless Agreement freely and voluntarily. I have been given a reasonable opportunity to review this Agreement and to consult with an attorney.
13. Under Georgia law, there is no liability for an injury or death of an individual entering these premises if such injury or death results from the inherent risks of contracting COVID-19. You are assuming this risk by entering these premises.
I HAVE READ THIS VOLUNTEER RELEASE, WAIVER AND HOLD HARMLESS AGREEMENT CAREFULLY AND FULLY UNDERSTAND ITS CONTENTS. NO ORAL REPRESENTATIONS, STATEMENTS OR INDUCEMENTS HAVE BEEN MADE BY ANY OF THE RELEASED PARTIES APART FROM THE FOREGOING WRITTEN AGREEMENT.
Signature of Volunteer: ______________________________________ Date: _____________________
In case of emergency, call: Name: ___________________________ Telephone: _______________
Check here to show you accept the terms stated above for yourself or for a minor volunteer for which you are a parental guardian.
I, _______________________, being the parent or legal guardian of ____________________ (the "Minor"), whom I represent
to be at least fifteen (15) years of age, hereby consent to and authorize the Minor to act as a v olunteer f or The United
Methodist Children's Home of the North Georgia Conference, Inc. d/b/a Wellroot Family Services ("Wellroot"). The Minor
has freely and voluntarily chosen to provide services ("Services") for UMCH. I understand and agree that, while the Minor
provides Services as a volunteer for Wellroot, there are certain risks (some of which I may not fully recognize) and that
injuries, death, property damage or other harm could occur to the Minor during or resulting from the provision of the Services.
I understand that, because of the potential danger in providing such Services, Wellroot is unwilling to allow the Minor to
provide Services unless I sign this Volunteer Release, Waiver and Hold Harmless Agreement for Minor. I therefore covenant
and agree, on behalf of myself, the Minor, and our respective heirs and representatives, as follows:
1. I accept and voluntarily assume all risks of any injuries, damages or harm which arise during or result from provision
of the Minor's Services, including any risk associated with any special medical needs or conditions that the Minor may have,
whether or not these risks are caused in whole or in part by the negligence or other fault of Wellroot or its directors, officers,
employees, agents or insurers (the "Released Parties").
2. I waive all claims against and hold harmless any and all of the Released Parties for any injuries, damages, expenses,
liabilities, losses or claims arising during or resulting from the Minor's provision of Services, whether known or unknown,
EXPRESSLY INCLUDING, BUT NOT LIMITED TO ANY INJURY, HARM, DEATH ARISING OUT OF OR RELATED IN
ANY WAY TO ANY ACTIVE OR PASSIVE NEGLIGENCE OF THE RELEASED PARTIES OR ANY OTHER PERSON OR
ENTITY, AND FOREVER RELEASE AND DISCHARGE THE RELEASED PARTIES FROM ALL SUCH CLAIMS.
3. I release and forever discharge the Released Parties from any claim whatsoever which arises or may hereafter arise on
account of any first aid, treatment, or medical service rendered in connection with the Minor's provision of Services.
4. I agree to hold harmless and indemnify the Released Parties from and against all liabilities, obligations, damages,
losses, claims, demands, recoveries, settlements, deficiencies, costs or expenses (including reasonable attorneys' fees) for any
injury and/or death to any person or damage to any property arising, or alleged to have arisen out of any reckless or intentional
act or failure to act on the Minor's part or arising from any untruthful information that the Minor may have provided to
Wellroot.
5. I understand that confidentiality concerning information pertaining to Wellroot is important. I agree to speak with the
Minor regarding the importance of maintaining the confidentiality of information gained through the Services that is not
publicly available or in the public domain. Generally speaking, all information that is not publicly available or in the public
domain is considered "confidential." I further agree to ensure that the Minor protects the privacy of Wellroot residents. I agree
to ensure that the Minor will not disclose the identities of residents of Wellroot whether through writing or photographs or
some other media, without the prior written consent of Wellroot. I understand that the Minor's disclosure of such information
could result in Wellroot terminating the Minor's volunteer Services.
6. It is my express intent that this Volunteer Release, Waiver and Hold Harmless Agreement for Minor shall bind the
Minor's successors, assigns, heirs, and personal representative.
7. I acknowledge and agree that this Volunteer Release, Waiver and Hold Harmless Agreement for Minor is intended to
be as broad and inclusive as permitted by the laws of the State of Georgia. If any portion of this Agreement is held invalid, it is
agreed that the balance of this Agreement shall continue in full legal force and effect.
8. I expressly grant and convey unto Wellroot all right, title, and interest in any and all photographic images and video or
audio recordings made by Wellroot during the Minor's provision of the Services, including, but not limited to, any royalties,
proceeds, or other benefits derived from such photographs or recordings. I agree that Wellroot may use such photographs or
recordings with or without the Minor's name and for any lawful purpose, including but not limited to such purposes as
publicity, illustration, advertising, and Web content.
9. I understand that the Minor is not an employee, and that except as otherwise agreed to in writing, Wellroot does not
carry or maintain health, medical, or disability coverage for volunteers. I understand that I am expected and encouraged to
obtain adequate health or medical insurance to cover any injury, loss of income, and loss of life that the Minor may suffer or
cause while providing Services at Wellroot.
10. The Minor and I agree to abide by the rules and policies adopted from time to time by Wellroot.
11. I covenant that the Minor will be supervised by me or another legally competent adult at all times. I understand that
my failure to supervise the Minor may result in our expulsion from the premises.
12. I expressly warrant that the Minor is capable of withstanding both the physical and mental demands of providing
Services.
13. I represent that I am of lawful age and legally competent to sign this Volunteer Release, Waiver and Hold Harmless
Agreement for Minor. I also understand and agree that the terms herein are contractual, and that they are not a mere recital or
simply for informational purposes.
14. I acknowledge that I am signing this Volunteer Release, Waiver and Hold Harmless Agreement for Minor freely and
voluntarily. I have been given a reasonable opportunity to review this Agreement and to consult with an attorney.
15. Under Georgia law, there is no liability for an injury or death of an individual entering these premises if such injury or
death results from the inherent risks of contracting COVID-19. You are assuming this risk by entering these premises.
I HAVE READ THIS VOLUNTEER RELEASE, WAIVER AND HOLD HARMLESS AGREEMENT FOR MINOR
CAREFULLY AND FULLY UNDERSTAND ITS CONTENTS. NO ORAL REPRESENTATIONS, STATEMENTS OR
INDUCEMENTS HAVE BEEN MADE BY ANY OF THE RELEASED PARTIES APART FROM THE FOREGOING
WRITTEN AGREEMENT.
Signature of Parent/Guardian: _____________________________________ Date: _________________
In case of emergency, call: Name: ___________________________ Telephone:
