Please complete this waiver form if you are volunteering with a group at A Precious Child. Once you complete the form, click the submit button at the bottom.

**Please Note: If you are under 18 years of age, you must complete the waiver form with a parent or guardian.

Contact Information

Employer/Group Name

Emergency Contact Information

Demographic Information

Demographic information is used only to help us get a better idea of the demographic make-up of our volunteers.

Medical Concerns/Physical Limitations

Do you have any medical concerns or physical limitations that we should be aware of or sensitive to?

How did you hear about us?

Please let us know how you were referred to volunteer at A Precious Child. (Please include any specific source names.)

I agree

The Volunteer understands, agrees, and freely, voluntarily, and without duress, gives this Release:

• My participation with A Precious Child is as a volunteer and not an employee.

• As a condition of being a volunteer, I will provide complete medical insurance coverage for any medical expenses that may be incurred as a result of my volunteer activities. I release and forever discharge A Precious Child and employees from any claim whatsoever which arises on account of any first aid, treatment or service rendered in connection with my volunteer work.

• I will indemnify A Precious Child against any and all liability or loss and against all claims or actions arising out of damage or injury to person or property caused by me.

• I understand that volunteering with A Precious Child may include activities that may be hazardous to me, which may include, but is not limited to bending, moving, lifting materials, moving furniture, trash removal, use of tools and equipment, loading and unloading supplies,.

• I authorize A Precious Child to publish, copyright, and lawfully use any photographic images, video, or audio recordings of me and any statements or testimonials made by me as a volunteer. I convey and grant all rights, including, but not limited to, any proceeds, royalties, or other benefits derived from such recordings or photographs.

• I assume all risks and liabilities that may result from my participation as a volunteer, and I release myself and my agents, executors, heirs and forever discharge and hold harmless A Precious Child, its employees, representatives, and agents from any and all actions, cause of action, claims, demands, and liabilities arising out of injury to or damage sustained by me. I will not seek loss wages, or other reimbursement that may incur due to a volunteer related injury.