Volunteer Registration & Waiver Form

Date of volunteer activity*

Date

First Name*

Last Name*

Mobile Number*

E-mail*

example@example.com

Would you like to receive CHS monthly emails?*

YesNo

Name of group/organization you are volunteering with? *

Job-site address*

Emergency Contact Name*

Emergency Contact Number*

Can we tag you on CHS Social Media Platforms?

YesNo

If yes, what is your social media handle?

FacebookInstagram

Community Housing Solutions

Waiver and Release of Liability

The volunteer named above (“Volunteer”) desires to volunteer for Community Housing Solutions of Guilford, Inc., a North Carolina nonprofit corporation (“CHS”), and engage in the activities related to being a volunteer. The Volunteer understands that the activities may include, but are not limited to, constructing and rehabilitating residential buildings, working in the CHS offices, and living in the housing provided for volunteers of CHS (the “Activities”). The Volunteer confirms they are at least 18 years old and voluntarily engaging in these activities and is not an employee of CHS. If the volunteer is under 18 years of age, a parent signature is required on this waiver.

Release and Waiver. Volunteer, for myself and anyone entitled to act on my behalf, does hereby release and forever discharge and hold harmless CHS, its directors, officers, employees, agents, and its successors and assigns (collectively “CHS Parties”) from any and all liability, claims, and demands of whatever kind or nature, either in law or in equity, which arise or may hereafter arise from Volunteer’s Activities with CHS. This release includes, but is not limited to claims arising under federal, state, local laws or local ordinances, including workers’ compensation claims. Volunteer understands that this release discharges CHS Parties from any liability or claim that the Volunteer may have against CHS Parties with respect to any bodily injury, personal injury, illness, death, or property damage that may result from Volunteer’s Activities with CHS, including COVID-19, whether caused by the negligence of any CHS Parties or otherwise. Volunteer also understands that CHS Parties do not assume any responsibility for or obligation to provide financial assistance or other assistance, including but limited to medical, health, or disability insurance in the event of injury or illness. Volunteer further agrees, despite this release, if I or anyone on my behalf makes a claim against CHS Parties, I will indemnify, save and hold harmless CHS Parties from any litigation expenses, attorney fees, loss, liability, damage or cost any may incur as a result of such claim.

Medical Treatment. Volunteer does hereby release and forever discharge CHS Parties from any claim whatsoever which arises or may hereafter arise on account of any first aid, treatment, or service rendered in connection with the Volunteer’s Activities with CHS.

Assumption of Risk. The Volunteer understands that the Activities include work that may be hazardous to the Volunteer, including, but not limited to, construction, loading and unloading, and transportation to and from the work sites. Volunteer hereby expressly assumes the risk of injury or harm in the Activities and release CHS Parties from all liability for injury, illness, death, or property damage resulting from the Activities. Volunteer understands they should not participate in the Activities unless they are physically and medically able.
Insurance. The Volunteer understands that CHS is not required to carry or maintain health, medical, or disability insurance coverage for any Volunteer.

Each Volunteer is encouraged to obtain his or her own medical or health insurance coverage.

Photographic Release. Volunteer does hereby grant and convey unto CHS all right, title, and interest in any and all photographic images and video or audio recordings made by CHS during the Volunteer’s Activities with CHS, including, but not limited to, any royalties, proceeds, or other benefits derived from such photographs or recordings.

Other. Volunteer expressly agrees that this release is intended to be as broad and inclusive as permitted by the laws of the State of North Carolina, and that this release shall be held to be invalid by any court of competent jurisdiction, the invalidity of such clause or provision shall be held to be invalid by any court of competent jurisdiction, the invalidity of such clause or provision shall not otherwise affect the remaining provisions of this release which shall continue to be enforceable.

I have read this release. I understand and consent to its terms, and I voluntarily sign this release of my own free act and will.*

Yes

Signature*

Parent Signature if Volunteer is Under the Age of 18