Volunteer Waiver - The WASH Foundation

VOLUNTEER WAIVER

Clean the World Foundation - Volunteer Liability Waiver
Clean the World is a 501 (c)(3) non-profit organization
Volunteer Name*
First Last
Date of Birth*
MM slash DD slash YYYY
Company / Organization*
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Email*
- I would like to be added to the mailing list.
Emergency Contact Name*
First Last
Emergency Contact Phone*
Volunteer Information
- Individual Volunteer
- Group
Name of Group
Volunteer Signature & Date
It is expressly understood that Clean the World, and their agents ad employees shall not be liable to any person, for any accident, injury, loss, or damage to any person, or property while in, upon or about, or entering or leaving said premises at any time during the term of service, resulting from any cause whatsoever, and all claims therefore are hereby released. I am medically fit to perform all activities as part of the program.

PHOTO RELEASE I hereby authorize and consent that Clean The World may copyright, publish, use, sell or assign any and all photographic portraits or pictures, television spots, movie films, videotapes and/or sound records or any part thereof, that they may have taken or made of me in which I may be included in whole or in part, whether separate from or in connection with illustrative or written manner, story or news item, motion pictures, television or radio spots, or for publicity, advertising or any other lawful purpose whatsoever, in conjunction with my name or in anonymity. I hereby waive any right I may have to inspect and/or approve the finished product or the advertising copy that may be used in connection therewith or the use to which it may be applied. Any portion of this Document deemed unlawful or unenforceable shall not affect the remaining provisions of the Document, and those remaining provisions shall continue in full force and effect.

I hereby authorize Clean the World to use my image/likeness both in video and print.
Date*
MM slash DD slash YYYY
Signature*
Parent / Guardian
If the above named person is under the age of 18, this waiver form must also be signed by a parent or guardian.
I, ________________________________(print name below), as the parent or guardian of the above named volunteer, authorize his/her participation in the Clean the World Volunteer Program and agree to the terms stated above.
I, ________________________________(print name below), as the parent or guardian of the above named volunteer, authorize his/her participation in the Clean the World Volunteer Program and agree to the terms stated above.
Parent/Guardian Signature
ACKNOWLEDGEMENT & ASSUMPTION OF RISKS

Clean The World Foundation, Inc. is a Florida-based 501 (c)3 nonprofit organization and the charitable arm of Clean the World Global LCC (both organization hereof referred to as “Clean the World”). Clean the World Foundation, Inc. is committed to reducing the waste created by discarded soap and shampoo products and preventing the millions of deaths caused by hygiene related illnesses around the world. The Clean The World activities in which I am involved (the”Clean the World Activities”) may involve significant risks, hazards, and/or dangers, some of which are inherent in the activities and cannot be eliminated or reduced (collectively, “Risks”). These Risks can cause many kinds of injury and/or loss, including but not limited to loss of property, damage to property, personal injury, illness, physical, mental or emotional trauma, disability and/or death (collectively, “Injury”). I understand that Clean The World does not want to frighten me or reduce my enthusiasm for the Clean The World Activities, but believes that it is important for me to be informed of the Risks of Injury.

The Risks include, without limitation:
• Working in dangerous circumstances, with limited access to medical care and proper sanitation.
• Working with dangerous equipment, which may break, fail, malfunction, or otherwise cause Injuries.
• Clean The World and any and all of its employees, volunteers, board members, contractors, partners, donors, and associates (“Clean The World Personnel”), many of whom are untrained volunteers, must make various judgments and decisions as they conduct the Clean The World Activities in changing outdoor and indoor environments. These judgments are, by their nature, imprecise and subject to error. Consequently, there are risks involved in such decision making and conduct, including, without limitation, the risk that Clean The World Personnel or other volunteers may misjudge Participant’s ability or preparedness to perform a given task, or may misjudge weather, terrain, water and/or river level, or may misjudge the necessity or propriety of medical treatment or lack thereof.
• The potential exists that Participant, Clean The World Personnel, other Clean The World volunteers, or third parties(e.g. rescue squad, hospital) may act carelessly, recklessly or generally fail to exercise due care.
• Clean The World Activities may take place in remote places, at a significant distance from medical facilities, where communication and transportation are difficult and where evacuation and medical care may be substandard or delayed.
• Such other risks, hazards, and dangers that are generally associated with volunteer relief work in the context of natural disasters, both during and before or after normal work/volunteering hours. These and other hazards and dangers may result in Injury to Participant, which includes without limitation, falling, being struck, dismembered or crushed, colliding with objects or people, experiencing vehicle collisions, being injured or sickened by machinery, objects, animals, water, mold, or people (collectively, “Injury”).

I understand that the above description of Risks and Injuries is not complete and that other unknown or unanticipated risks, hazards, and dangers may result in Injury or other loss. I acknowledge that participating in the Clean The World Activities may require a degree of skill and knowledge different from other activities and that I have responsibilities as a Participant. I warrant that I have no mental or physical problems or limitations that might compromise or affect my ability to participate in Clean The World Activities, and I represent that I am fully capable of participating in these activities without causing harm to others or myself. I acknowledge that Clean The World and Clean The World Personnel are, and have been available, to answer any and all questions I may have had about the nature and physical demands of these activities and the risks, hazards, and dangers associated with these activities. I understand that presence of any Clean The World Personnel is no assurance of my safety or any lessening of the Risks, and I nonetheless undertake to participate in the Clean The World.

My participation in the Clean The World Activities is purely voluntary and I choose to participate in spite of and with knowledge of the Risks. Therefore, in exchange for being allowed to participate in the Clean The World Activities, I assume and accept full responsibility for myself, for those Risks identified here and for those risks not identified, and for all Injury, death, property loss or expenses suffered by myself or by any third party arising out of those Risks and/or my own negligence or (to the extent allowed by applicable law) the negligence of Clean The World or others.

RELEASE & INDEMNITY

I hereby agree, on behalf of myself and my children, heirs, executors, administrators and representatives, to the fullest extent allowed by applicable law, to release, indemnify and defend Clean The World and Clean The World Personnel with respect to all claims, liabilities, losses, suits or expenses (including costs and reasonable attorneys fees) made or brought by anyone, including myself, any co-Participant, volunteer, third party, or any members of my family arising out of any injury, damage, death, or other loss in any way connected with my participation in Clean The World Activities or use of Clean The World equipment or facilities. This agreement includes any losses claimed to be caused, in whole or in part, by the negligence of Clean The World or Clean The World Personnel. I agree to waive all claims against Clean The World or Clean The World Personnel, whether legal or equitable, and I agree that neither I, nor anyone acting on my behalf, will make a claim or file a lawsuit of any kind against Clean The World or Clean The World Personnel as a result of any injury, damage, death or other loss.

I agree that this and all other aspects of my relationship with Clean The World are governed by Florida law. Further, any mediation, suit, or other proceeding arising out of or relating to my participation in Clean The World Activities, must be filed exclusively in the State of Florida, and Florida law shall apply. I agree to settle any dispute that cannot be settled by discussion through mediation before a mutually acceptable Florida mediator. I also agree that if I, or someone on my behalf, asserts(s) a claim or file(s) a suit against Clean The World or Clean The World Personnel, I will pay all costs and attorney’s fees incurred by Clean The World in defending that claim or suit, if the claim or suit is withdrawn or dismissed, or to the extent a court determines that Clean The World and/or Clean The World Personnel is not responsible for the injury or loss.

While I agree that Clean The World has no responsibility to provide medical care to me and makes no offer to do so, I authorize Clean The World Personnel, should they deem it necessary, to obtain or provide such medical care for me as they deem appropriate, and/or to transport me to a medical facility should they deem it appropriate. I further authorize Clean The World Personnel or any medical personnel to render such treatment they deem necessary for my health. I further agree to pay all costs associated with such care or evacuation whether or not authorized by me. Without limiting any of the foregoing, I expressly waive any claims that I or anyone on my behalf may make against Clean The World or Clean The World Personnel with regard to medical care and the provision or failure to provide such care.
*
- I agree to the terms and assumption of risk as stated above.

Clean the World Foundation - Volunteer Liability Waiver

Volunteer Signature & Date

Parent / Guardian

ACKNOWLEDGEMENT & ASSUMPTION OF RISKS

Thank you so much for your submission!

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