RECONCILIATION SERVICES
Volunteer Waiver, Agreement & Authorization
3101 Troost Ave, Kansas City, MO | 816-931-4751 | rs3101.org
In consideration of this opportunity to volunteer with Reconciliation Services in the kitchen, social service program, Foster Grandparent Program or internal/external events, I AGREE TO THE FOLLOWING TERMS & CONDITIONS, intending to be legally bound by them: I will abide by the mission, rules, regulations, policies and programs of Reconciliation Services/Thelma's Kitchen, (hereinafter referred to as RS) while I am a volunteer.
HEALTH AND PHYSICAL CONDITION
I fully understand the nature of the volunteer activities that I will be performing on behalf of RS and hereby confirm that I am qualified, in good health, and in proper physical condition to participate in such activities. I further agree and promise that if at any time I believe conditions associated with such activities are unsafe, I will immediately discontinue further participation in such activities and will advise RS staff of the perceived unsafe conditions.
ASSUME RISK
I assume all risks in connection with my volunteer work for RS. I acknowledge and agree that RS, its directors and officers, its volunteers or any of its representatives, are not liable to me for any injuries, damages, liabilities, losses, judgments, costs or expenses which I might suffer or sustain in connection to the performance of my volunteer activities for RS.
HOLD HARMLESS
On behalf of myself, my heirs, personal representatives and assigns, I hereby release, discharge, indemnify and hold harmless RS and its directors, officers, employees, volunteers and agents from any claims, causes of action and demands of any nature, whether known or unknown, arising out of or in connection with my volunteer work for RS. I will indemnify, defend and hold RS harmless from and against any claims, lawsuits, injuries, damages, losses, costs or expenses sustained by any person in connection with my participation in RS activities, including but not limited to my intentional misconduct or grossly negligent performance of volunteer activities for RS, or my breach of RS rules, regulations, policies and programs.
RS PROPERTY AND SUPPLIES
If I suspend volunteer activities, or upon request, I will promptly return all RS supplies, equipment, records, moneys and other items in good, clean, serviceable condition. I acknowledge and agree that RS shall have the right to terminate my involvement at any time with or without prior notice. Any modification to this Agreement must be in writing and signed by both parties. This Agreement is binding upon RS, its representatives, me and my respective heirs, successors, assigns, executors and personal representatives.
PHOTOGRAPHY RELEASE
I grant and convey to RS all right, title and interest in any and all photographic images in which I appear including video or audio recordings, made by RS or others on RS's behalf during my volunteer work for RS including, but not limited to, any royalties, proceeds, or other benefits derived from such photographs or recordings.
MEDIA & COMMUNICATIONS RELEASE
In addition to the Photography Release above, I authorize Reconciliation Services to use my name, image, likeness, voice, and biographical information in connection with any media or communications produced by or on behalf of RS, including but not limited to: print and digital publications, social media platforms, websites, newsletters, fundraising materials, grant applications, and broadcast or online video content. I understand that I will not receive compensation for such use. I further understand that RS will make reasonable efforts to use my likeness respectfully and in a manner consistent with its mission, and that I may request removal of specific content by contacting RS staff in writing.
MEDICAL TREATMENT AUTHORIZATION
I understand that Reconciliation Services does not provide medical care or health insurance to volunteers. In the event that I am injured or become ill during volunteer activities and I am unable to communicate my own medical decisions, I authorize RS staff to contact emergency medical services (911) on my behalf and to share this form with responding medical personnel. I acknowledge that RS is not responsible for the cost of any medical treatment I receive, and that I should carry my own health insurance or be prepared to assume personal responsibility for medical costs incurred.
STATE OF MISSOURI LEGAL
I EXPRESSLY AGREE that this Waiver is intended to be as broad and inclusive as permitted by the laws of the State of Missouri, and that this Waiver shall be governed by and interpreted in accordance with the laws of the State of Missouri. I agree that in the event that any clause or provision of this Waiver 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. I agree to all the terms stated above. I will abide by them and not dispute or take issue with them in any way. I understand and agree that submitting this application form does not automatically register me as an RS volunteer, and that there may be certain qualifications I must meet, including the acceptance of established volunteer policies and procedures before I begin volunteering.
FINAL AGREEMENT
By submitting the application, I attest that the information I have provided on the form is true and accurate and am in agreement with the following statements:
1. I have read and understand the RS Volunteer Terms & Conditions stated above.
2. I will not present for volunteer opportunities if I am ill, have any infectious illness or have had a fever, vomiting, or diarrhea within 24 hours of my volunteer shift.
3. I will comply with volunteer restrictions and/or exclusions that have been provided by RS staff.
