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For questions, please contact:

volunteer@annsheart.org


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Your information


Required fields are marked with an asterisk (*).
First Name *
Last Name *
Date of Birth *

A valid date as MM/DD/YYYY (for example: 11/30/2015)
Mobile Phone *

For example, 123-456-7890
SMS (text) messaging:
You may opt-in to receive SMS (text) for Ann's Heart volunteer activities, including shift reminders and cancellations.

To opt-out, reply STOP to any SMS message OR update the SMS opt-in setting in your profile.
Emergency Contact First Name *
Emergency Contact Last Name *
Emergency Contact Mobile Phone Number *
Emergency Contact Relationship *

Waiver

WAIVER OF LIABILITY



ANN’S HEART VOLUNTEER AGREEMENT


General Understandings.


I recognize that, as an Ann’s Heart volunteer, I represent Ann’s Heart to the public. I accept responsibility for this status and will conduct myself in a professional manner. I will not
participate in, and, will report to Ann’s Heart Volunteer Coordinator or any other person so designated by Ann’s Heart, any and all instances of any sort of harassment, exploitation, and/or
intimidation. I will work to maintain an atmosphere of physical and emotional safety for everyone associated with Ann’s Heart, including its employees, volunteers, clients, and visitors.

I agree to maintain the confidentiality of Ann’s Heart volunteers, clients and donors about whom I may have personal and identifying information. I understand that I am prohibited from
photographing, audio taping or videotaping any client of Ann’s Heart without management direction. This includes the use of any type of cellular phone camera, digital camera, video camera, tape recorder, or other form of image or audio recording device.

I agree to honor the commitment of length and frequency of service that I make to Ann’s Heart.
I agree to provide as much advance notice as is possible if I will be absent from my volunteer shift.
I agree to update my personal information and emergency information as changes occur.

Use of Image and Likeness.


I understand that while volunteering, I may be interviewed, photographed and/or videotaped, and my image and likeness may be used for broadcast, publicity or Ann’s Heart’s promotional materials (including website, print, and e-mail). If I do not want my image and likeness used for these purposes, I must notify the Volunteer Coordinator of my wishes in writing. Upon signing the Photo Release Form, I release the use of my likeness and image for Ann’s Heart’s use for funding reports and broadcast, publicity or Ann’s Heart’s promotional materials. I also understand that no royalty, fee or other compensation shall become payable to me by reason of such use.

Release and Waiver.


I, for myself and on behalf of my assignees, heirs, guardians, and other legal representatives hereby voluntarily and without duress release and forever discharge and hold harmless Ann’s Heart, and it’s successors and assigns from any and all liability, claims, and demands of any kind whatsoever, whether in law or equity, which arise or may hereafter arise from my volunteer activities. I am aware that as an Ann’s Heart Volunteer I expose myself to potential hazards, including but not limited to falls or injuries that could occur during the process of moving, stacking and storage of boxes and cans of food. Potential hazards have been explained to me. I understand that this release discharges Ann’s Heart from any and all liability or claim that I or my assignees, heirs, guardians, and other legal representatives may have with respect to any bodily injury, illness, death or property damage resulting from my volunteer activities, whether caused by the negligence of Ann’s Heart or it’s officers, directors, employees, clients, agents, volunteers, or otherwise.

Assumption of Risk.


I am voluntarily participating in this service with the knowledge of the potential hazards involved and hereby expressly assume and accept any and all risks of injury or harm resulting from my volunteer activities. Furthermore, any damages caused by me as the result of my participation as a volunteer shall be my sole responsibility and I voluntarily and expressly forever indemnify, hold harmless and defend Ann’s Heart from and against any and all resulting claims, actions or damages of whatever nature resulting from my activities.

Medical Treatment Release.


I hereby voluntarily and without duress release and forever discharge and hold harmless Ann’s Heart from any claim, action or demand whatsoever arising from any first aid or other emergency medical services rendered in connection with my volunteer activities.

No Insurance.


I understand that except as may be expressly agreed to in writing, Ann’s Heart does not carry or maintain and has no obligation to carry or maintain any health, medical or disability insurance for my benefit. I understand that any medical bills that may be incurred for injuries that I may suffer while performing services for Ann’s Heart are my responsibility.

Scope, Severability and Governing Law.


I expressly agree that this Release is intended to be as broad and inclusive as permitted by the laws of the Commonwealth of Pennsylvania. This Release shall be governed by the laws of the Commonwealth of Pennsylvania. I agree that if any clause or provision of this Release is determined by a court of competent jurisdiction to be invalid, the invalidity of such clause or
provision shall not affect the validity of the remaining clauses and provisions of this Release, which shall remain in full force and effect.

I have carefully read this Release and fully understand its contents. I am aware that this is a waiver and release of liability and I agree to it of my own free will.