As part of your work with you may have access to view, update or modify sensitive information. You must treat this information as confidential and not share with anyone unless specifically authorized. The Initiative defines Sensitive Information as:

• Client names, nicknames or any other identifying information
• Client address, location or whereabouts
• Client personal finance information including social security numbers, financial data or related information
• Client health information including information on medical conditions, treatment or history

All information collected, accessed or viewed as part of the Initiative is to be treated as confidential in written, electronic, printed and all other forms. Information is the shared property of the Initiative and the entity signing this agreement and should not be released, shared or discussed without prior authorization. This includes communication in any form with clients, co-workers, researchers, outside agencies or any other party. 

Unauthorized disclosure of information may result in disciplinary or legal action or may result in dismissal from the Initiative. 

As a participant with the Initiative, I understand I will have access to view, update or modify sensitive information. I understand and agree that I must maintain and safeguard the confidentiality of client information and other information that I may obtain through my activities with the Initiative. I also agree that such information shall be discussed only within the boundaries of my participation with the Initiative and the Housing Navigation Team. I agree not to divulge, publish or otherwise make known to unauthorized persons or to the public any identifiable personal information which is obtained in the course of my service as a participant on the Housing Navigation Team. I recognize that unauthorized release of confidential information may result in disciplinary or legal action and may result in dismissal from the Initiative. 

In consideration for being allowed to participate as a volunteer in the Columbus Point in Time count, Home for Good and United Way of the Chattahoochee Valley on behalf of myself and my next of kin, heirs and representatives, I release from all liability and promise not to sue the Columbus Point in Time count, Home for Good and United Way of the Chattahoochee Valley and collectively its’ contractors, employees, officers, directors, volunteers and agents (“Survey Process Leadership”) from any and all claims, including claims of negligence, resulting in any physical or psychological injury (including paralysis and death), illness, damages or economic or emotional loss I may suffer because of my participation in the Survey Process, including travel to and from and during the Survey Process. 

I am voluntarily participating in the Survey Process. I am aware of the risks associated with traveling to/from and participating in Survey Week, which include but are not limited to physical or psychological injury, pain, suffering, illness, disfigurement, temporary or permanent disability (including paralysis), economic or emotional loss, and/or death. I understand that these injuries or outcomes may arise from my own or other’s actions, inaction, or negligence; conditions related to travel; or the condition of the Survey Process location(s). Nonetheless, I assume all related risks, both known or unknown to me, of my voluntary participation in the Survey Process, including travel to, from and during the Survey Process.

I agree to hold the Survey Process Leadership harmless from any and all claims, including attorney’s fees or damage to my personal property that may occur as a result of my voluntary participation in the Survey Process, including travel to, from and during the Survey Process. If the Survey Process Leadership incurs any of these types of expenses, I agree to reimburse the Survey Process Leadership. If I need medical treatment, I agree to be financially responsible for any costs incurred as a result of such treatment. I am aware and understand that I should carry my own health insurance. 

In consideration for my acceptance as a participant the Survey Process, and the services and amenities to be provided by the Survey Process Leadership in connection with the Survey Process, I confirm my understanding that: 

• I have read any rules and conditions applicable to the Survey Process made available to me and I acknowledge my participation is at the discretion of the Survey Process Leadership.

 

• The Survey Process officially begins and ends at the location(s) designated by the Survey Process Leadership. The Survey Process does not include carpooling, transportation, or transit to and from the Survey Process, and I am personally responsible for all risks associated with this travel.

 

• If I decide to leave early and not to complete the Survey Process as planned, I assume all risks inherent in my decision to leave and waive all liability against the Survey Process Leadership arising from that decision. Likewise, if the Survey Process Leadership has concluded the Survey Process, and I decide not to return to the end location designated by the Survey Process Leadership, I assume all risks inherent in my decision to go forward and waive all liability against the Survey Week Leadership arising from that decision.

 

• This Agreement is intended to be as broad and inclusive as is permitted by law. If any provision or any part of any provision of this Agreement is held to be invalid or legally unenforceable for any reason, the remainder of this Agreement shall not be affected thereby and shall remain valid and fully enforceable.

 

• To the fullest extent allowed by law, I agree to WAIVE, DISCHARGE CLAIMS, AND RELEASE FROM LIABILITY the Survey Process Leadership, its officers, directors, employees, agents, and leaders from any and all liability on account of, or in any way resulting from Injuries and Damages, even if caused by negligence of the Survey Process Leadership, its officers, directors, employees, agents, and leaders, in any way connected with the Survey Process. I further agree to HOLD HARMLESS the Survey Process Leadership, its officers, directors, employees, agents, and leaders from any claims, damages, injuries or losses caused by my own negligence while a participant in the Survey Process. I understand and intend that this assumption of risk and release is binding upon my heirs, executors, administrators and assigns.

 

• I have read this document in its entirety and I freely and voluntarily assume all risks of such Injuries and Damages and notwithstanding such risks, I agree to participate in the Survey Process.

I do hereby consent and agree that the Survey Process Leadership, its employees, or agents have the right to take photographs, videotape, or digital recordings of me to use in any and all media, now or hereafter known, and exclusively for the purpose of the Survey Process Leadership. I further consent that my name and identity may be revealed therein or by descriptive text or commentary. 

I do hereby release to the Survey Process Leadership, its agents, and employees all rights to exhibit this work in print and electronic form publicly or privately and to market and sell copies. I waive any rights, claims, or interest I may have to control the use of my identity or likeness in whatever media used. 

I am 18 years or older. I understand the legal consequences of signing this document, including (a) releasing the Survey Process Leadership from all liability, (b) promising not to sue the Survey Process Leadership, (c) and assuming all risks of voluntarily participating in the Survey Process, including travel to, from and during the Survey Process. 

I understand that this document is written to be as broad and inclusive as legally permitted by the State of Georgia. I agree that if any portion is held invalid or unenforceable, I will continue to be bound by the remaining terms. 

I have read this entire document and I am signing it freely. No other representations concerning the legal effect of this document have been made by me. 

I agre to volunteer my time and services for United Way of the Chattahoochee Valley (UWCV) and hereby acknowledge that said organization is doing its utmost to protect the public as well as myself as a volunteer. To this extent, I agree to follow Center of Disease Control (CDC) and local health district guidelines, policies, and procedures for social distancing to reduce the spread of Novel Coronavirus, or COVID-19. This will require me to maintain six (6) feet of distance between myself, fellow volunteers, and patrons of the organization as much as possible. 

I agree to utilize surgical masks or improvised masks such as scarves, bandanas, and handkerchiefs to reduce the risk of exposure to myself and others. I agree to wash or sanitize my hands after using the restroom, sneezing, and coughing, and before eating or preparing meals. 

United Way of the Chattahoochee Valley is not responsible for any exposure to Novel Coronavirus, or COVID-19. I hereby release, indemnify, and hold harmless UWCV, the organizers, sponsors, agency partners and supervisors of all its activities, from any and all liability in connection with any injury (including any injury caused by negligence), including illness. I understand that there is no employment security insurance provided to me in my role as a volunteer. 

By signing below, I certify that I am over the age of 18 and agree to comply with the written instructions above. Failure to comply with these written instructions or verbal instructions from staff may result in my volunteer privileges being removed and I may be asked to leave the premises. 

Photo Release

I hereby grant permission to UWCV to use my story and/or its likeness and any photographs provided in any and all United Way printed materials, video presentations, web site or media releases without further consideration, and I acknowledge United Way’s right to crop or edit such materials at its discretion. I also acknowledge that United Way may choose not to use my story and/or image at this time but may do so at its own discretion at a later date.

Personal Devices

To mitigate sharing devices and maintain proper distance during this pandemic, we ask that volunteers utilize their own mobile devices to complete the Point In Time Count surveys. We further ask that the volunteer install the Counting Us app. After the Point In Time Count is complete, we request the volunteer remove sensitive and confidential information from their device to safeguard privileged information.

I agree to use my mobile device to conduct the Point In Time Count. I agree to use the Counting Us app to collect survey results as requested. I understand unauthorized disclosure of information may result in disciplinary or legal action or may result in dismissal from the initiative.