I understand and agree that submitting this application form does not automatically register me as a Mid Central Community Action, Inc. volunteer, and that there may be certain qualifications I must meet, including the acceptance of established volunteer policies and procedures before I may begin volunteering.
Affidavit of Confidentiality:
Mid Central Community Action, Inc. adheres to the principle of maximum confidentiality and follows the mandates of the Illinois statutes and regulations as from time to time provided, and as currently specified in the Mental Health Confidentiality Act. Accordingly, all board members, staff, volunteers, and others associated with the operation of this agency shall keep all information regarding clients or agency business in general in strictest confidence. I understand the requirements for confidentiality and agree to abide thereby. I further understand that a violation of confidentiality requirements could result in immediate termination of my involvement with MCCA.
Volunteers give MCCA the right to use any images of any MCCA activities in which they participate in for both internal and external promotional and communication reasons.
I release Mid Central Community Action, Inc. (MCCA) and its trustees, directors, officers, employees, agents, volunteers, successors, and assigns from any and all liability for, and waive any and all claims for, injury, loss, or damage in any way connected with my participation, including injury, loss, or damage caused in whole or in part by the negligence or other misconduct of MCCA or any of the above-listed organizations or individuals.
I am aware of the risks of participating, and assume all risks, foreseeable and unforeseeable, in any way connected with my participation. I agree to indemnify and to hold harmless MCCA and any of the above-listed organizations or individuals with regard to any claim or expenses (including attorneys’ fees and other costs of defending any claim by a third party or that I might make, or that might be made on my behalf) in any way connected with a claim.