PLEASE READ ALL THE FOLLOWING INFORMATION AS YOU WILL BE ELECTRONICALLY SIGNING YOUR CONSENT WITH YOUR SUBMISSION OF THIS ONLINE FORM...
I AGREE, and understand that submitting this application form does not automatically register me as a Anchor Center for Blind Children volunteer, and that there may be certain qualifications I must meet, including the acceptance of established volunteer policies and procedures before I may begin volunteering.
Statement of Commitment:
Volunteering can be a fun activity and very rewarding, but it is also a very serious commitment. Volunteering requires that you be willing to learn, work hard and be responsible and open to new experiences. Participants in our volunteer program are responsible to adhere to their job descriptions/assignments including delegated time commitments.
Please consider carefully whether this time commitment will fit your schedule or other life commitments. You must have the willingness and ability to make a commitment to your volunteer assignment. Anchor Center for Blind Children depends on you.
Volunteer Authorization, Waiver and Release Form
The volunteer understands, agrees, and voluntarily "signs" this release:
• My participation with Anchor Center for Blind Children is as a volunteer and not an employee.
• As 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 Anchor Center for Blind Children and employees from any claim which arises on account of any first aid, treatment or services rendered in connection with my volunteer work.
• I assume all risks and liabilities that may result from my participation as a volunteer and I will not seek loss wages, or other reimbursement that may incur due to a volunteer related injury.
• I understand that volunteering with Anchor Center for Blind Children may include activities that may be hazardous to me, which may include, but are not limited to lifting children, being exposed to viruses and communicable diseases, moving materials and equipment, loading and unloading supplies and equipment, and use of tools and equipment.
• I authorize Anchor Center for Blind Children to publish and lawfully use any photographic images, videos, or audio recordings of me and any statements or testimonials made by me as a volunteer.
• If volunteering on a regular basis, I authorize Anchor Center for Blind Children to complete a full background check of my information and understand that if certain results matching my information are found, I will not be allowed to volunteer.
• I understand that confidentiality is a crucial aspect of the programs and services at Anchor Center for Blind Children. I agree that anything I see, hear, or read, and anything I already know about a child and/or his/her family will be kept confidential.
I understand that confidentiality is an important part of the programs at Anchor Center. I agree to that I will not share any identifying information about a child or his/her family in any capacity with anyone outside of Anchor Center. I agree that all information observed or gained during my participation in all programs at Anchor Center will be kept confidential.
COVID WAIVER: READ CAREFULLY -- BY SIGNING THIS DOCUMENT YOU MAY GIVE UP IMPORTANT LEGAL RIGHTS.
WAIVER AND RELEASE OF LIABILITY FOR VOLUNTEERS
On March 10, 2020, Colorado Governor Jared Polis declared a disaster emergency for Colorado relating to the COVID-19 outbreak, on March 11, 2020, the World Health Organization declared the COVID-19 outbreak a global pandemic, and on March 13, 2020, President Donald Trump declared the COVID-19 outbreak a national health emergency. Given the severity of the COVID-19 pandemic, and in anticipation of my volunteer placement at Anchor Center for Blind Children, which operates a child care facility, I hereby make the following waiver, release and other representations and covenants set forth herein in favor of Anchor Center for Blind Children.
Acceptance of Risk; Release; Indemnification. The safety and security of its employees and volunteers remains a top priority of Anchor Center for Blind Children. Although the risk of exposure to COVID-19 across Colorado is reported to be steadily decreasing, I understand that there is still significant risk associated with volunteering, including but not limited to, increased social contact and interaction with the public. To help reduce the spread of COVID-19 and to protect Anchor Center for Blind Children’s employees and volunteers, Anchor Center for Blind Children encourages all employees and volunteers to adhere to all safety and health guidelines for the prevention of COVID-19, including those issued by the Colorado Department of Public Health and Environment, the Occupational Safety and Health Administration and the Centers for Disease Control and Prevention. Employees and volunteers are advised to frequently wash their hands with soap and water for at least twenty seconds (or, if soap is not available, use an alcohol-based hand sanitizer), exercise respiratory etiquette (including coughing and sneezing into a tissue or into their upper sleeve), avoid touching their face, exercise social distancing when possible, sanitize surfaces and objects frequently used, wear personal protective equipment such as face masks and gloves and follow any and all other preventive measures recommended by applicable authorities. Notwithstanding the foregoing, I understand that the above guidelines do not completely eliminate my risk of exposure to COVID-19 and, should I experience any COVID-19 related symptoms (such as fever, cough, body aches, or shortness of breath), I am advised to immediately return home and follow the advice of my healthcare provider, clinic, or hospital. In such case, I will immediately alert my supervisor of such symptoms.
Regardless of any steps taken by Anchor Center for Blind Children to reduce the risks associated with the COVID-19 pandemic, I am fully aware that there are a number of risks associated with volunteering at Anchor Center for Blind Children during the COVID-19 pandemic, including without limitation, being exposed to and contracting COVID-19 from children and other individuals, surfaces, and/or airborne particles. I understand that contracting COVID-19 could result in serious medical symptoms requiring medical treatment in a hospital or even death. On behalf of myself my heirs, successors and assigns, I knowingly and freely, assume all such risks, both known and unknown, relating to my volunteering at Anchor Center for Blind Children arising from or relating to COVID-19, including all illnesses, injuries, damages or death arising therefrom, and I hereby forever release, waive, relinquish, and discharge Anchor Center for Blind Children, along with Anchor Center for Blind Children’s shareholders, officers, directors, members, managers, officials, partners, trustees, agents, contractors, employees, affiliates, or other representatives, and their successors and assigns, from any and all claims, demands, liabilities, rights, damages, expenses, and causes of action of whatever kind or nature, and other losses of any kind, whether known or unknown, foreseen or unforeseen, (collectively, “Damages”) arising from or relating to COVID-19 as a result of my volunteering at Anchor Center for Blind Children, and including but not limited to claims based on the alleged negligence of any member of Anchor Center for Blind Children organization or any other person. I further promise not to sue Anchor Center for Blind Children or any member of the organization for any illness, injury, death or other Damages arising out of or related to COVID-19 and agree to indemnify and hold them harmless from any and all Damages resulting therefrom as a result of my employment at Employer.
If any provision of this Waiver and Release of Liability is declared invalid, the remaining provisions remain enforceable. I may seek advice from legal counsel before signing this Waiver and Release of Liability. By signing this Waiver and Release of Liability, I acknowledge that either I have sought the advice of legal counsel or wish to waive the opportunity to seek the advice of counsel before signing.
READ CAREFULLY -- BY SIGNING THIS DOCUMENT YOU MAY GIVE UP IMPORTANT LEGAL RIGHTS.
Behavior Policy: volunteers are to abstain from any drinking and or eating of event food. If a volunteer is found to be drinking alcohol they will be asked to leave. Special volunteer food and drink will be provided.
By submitting this form, I attest that the information I have provided on the form is true and accurate.
By submitting this form, I attest and understand my electronic signature agreement to Anchor Centers Volunteer Authorization, Waiver and Release Form, and Confidentiality Agreement.
By submitting this form, I understand that there will be a time commitment and that if assigned to a Volunteer position am obligated to be on time, communicate changes in my scheduled time, and commitment to my assigned role.