Voluntary Participation: I acknowledge that I have voluntarily applied to
participate in the Hearts and Hands,
Inc. and Rebuilding Together *Montgomery County Home Repair Project (the “Project”), a project in which
volunteers will repair the homes of disadvantaged persons. I understand that as a volunteer, I will not
be paid for my services. I further agree
that my participation in the Project may be terminated at any time by Hearts and Hands, Inc. (H&H) and/or
Rebuilding Together, Montgomery County (“RT*MC”).
Assumption of Risks: I AM AWARE THAT BY PARTICIPATING IN THE PROJECT, I MAY BE EXPOSED TO
PERSONAL INJURY, DEATH OR DAMAGE TO MY PROPERTY AS A RESULT OF MY ACTIVITIES,
THE ACTIVITIES OF OTHER PERSONS, OR THE CONDITIONS UNDER WHICH MY VOLUNTEER
SERVICES ARE PERFORMED. WITH KNOWLEDGE
OF THESE RISKS, I AGREE TO ACCEPT ANY AND ALL RISKS OF PERSONAL INJURY, DEATH
OR DAMAGE TO MY PROPERTY, AND I VERIFY THIS STATEMENT BY PLACING MY INITIALS HERE__________,
INCLUDE PARENT/GUARDIAN’S INITIALS IF A MINOR ________.
Release: In
consideration of the opportunity afforded me to participate in the Project, I
hereby agree that I, my successors, assignees, heirs, guardians and legal
representatives, will not make any claim against Hearts and Hands, Inc.
(H&H) and/or RT*MC or any of its affiliated organizations, or their
officers, directors, or employees, or any suppliers of any materials or
equipment that are used during the Project; any of the Project or H&H /
RT*MC volunteers or sponsors, or any homeowner participating in the Project for
injury, death, or damage resulting from the act or omissions of any person or
entity, arising from my participation in the Project provided, however, that
the injury, death or damage was not caused by an act or omission that was
reckless, wanton, intentional, or grossly negligent. Without limiting the generality of the
foregoing, I hereby waive and release my rights, actions or causes of action
resulting from personal injury to me or my death, or damage to my property,
sustained in connection with my participation in the Project; If I am less than 18 years of age,
my parent or guardian waives and releases these rights on my behalf; provided,
however, that the injury, death or damage was not caused by an act or omission
that was reckless, wanton, intentional, or grossly negligent.
Consent: I
further consent to the unrestricted use by (H&H) / RT*MC and/or any person
authorized by them of any photographs, recordings, interviews, videotapes,
motion pictures or similar visual or auditory recording of me created in
connection with the Project.
Knowing and Voluntary Execution: I HAVE CAREFULLY
READ THIS AGREEMENT AND FULLY UNDER-STAND ITS CONTENTS. I AM AWARE THAT THIS IS A CONTRACT AND A
RELEASE OF LIABILITY BETWEEN ME AND H&H / RT*MC AND I SIGN IT OF MY OWN
FREE WILL. BY SIGNING THIS AGREEMENT, I
CERTIFY THAT I AM EIGHTEEN YEARS OF AGE OR OLDER OR IF I AM UNDER 18 YEARS OF
AGE, WHICH I HAVE THE CONSENT, WAIVER AND AGREEMENT OF MY PARENT OR GUARDIAN AS
EVIDENCED BY HIS/HER SIGNATURE BELOW TO PARTICIPATE PURSANT TO THE ABOVE
AGREEMENT, RELEASE AND WAIVER.
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IF VOLUNTEER IS A
MINOR, PARENT/GUARDIAN SIGNATURE IS REQUIRED
I represent and warrant to H&H and RT*MC that I am the parent or legal guardian of the minor named above. The above named minor has my permission to participate in the Project. I have read and understand the terms and conditions of the Volunteer’s Agreement and Release. On behalf of such minor and myself, I agree to all of the terms and conditions of the Volunteer’s Agreement and Release.
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Parent/Guardian
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