This is a legal document that affects your legal rights, please read it carefully before signing. Thanks!
VERY IMPORTANT - everything I see and hear during my volunteer time is strictly confidential and a violation of Federal HIPAA privacy laws should I discuss or infer any information about clients of JCSH outside of JCSH.
By signing below, I am applying for a volunteer position with Jewish Community Services of Hawaii (JCSH) and agree on the following terms, conditions, and understandings.
1. My service to JCSH is provided strictly in a voluntary capacity as a volunteer, and without any express or implied promise of salary, compensation, or other payment of any kind whatsoever.
2.My services are furnished without any employment-type benefits, such as employee health insurance, worker's compensation, retirement plans and the accrual in any form of paid time off, vacations and sick time. My personal health insurance plan is the primary insurance for any accidents or injuries that may occur because of my volunteering with JCSH.
3. Medical Treatment: I hereby release and forever discharge JCSH from any claim whatsoever which arises or may hereafter arise on account of any first aid, treatment, or service rendered in connection with my volunteer activities on behalf of the organization.
4. Insurance: I understand that JCSH does not carry or maintain health, medical, or disability insurance coverage for any volunteer. Each volunteer is expected and encouraged to obtain their own health insurance coverage.
5. Release and Waiver: I understand that interacting with clients is usually a very satisfying experience but that at times I could be exposed to a client with mental health challenges and could result in emotional or physical harm. On behalf of myself, and my heirs, personal representatives and assigns, I hereby release, discharge, indemnify and hold harmless the organization and its directors, officers, staff, volunteers, guests, vendors, and agents from any and all claims, causes of action and demands of any nature, whether known or unknown, arising out of or in connection with my volunteer activities on behalf of JCS including, without limitation, damages related to bodily injury, personal injury, illness, death or property damage.
6.Photographic Release: Understanding that public relations is an important part of a volunteer's activities on behalf of the organization, I hereby grant JCS non-exclusive right and license to display, exhibit, transmit, broadcast, reproduce, record, photograph, digitize, adapt, create derivative works, exploit, and otherwise use my name, image, and likeness, and all materials created by or on behalf of the organization that incorporate any of the foregoing on a perpetual basis throughout the world, and in any medium or format whatsoever, whether now existing or hereafter created, without further consent from or royalty, payment, or other compensation to me for public relations purposes. If my image is going to be used, I will be told and asked about it first.
7. I will familiarize myself and comply with all JCSH policies and procedures applicable to volunteers. I fully understand that the organization expects high standards of moral and ethical behavior in my capacity as a volunteer. I will seek clarification from the organization when required.
8. I understand that the organization, without notice or hearing, may terminate my services as a volunteer at any time, with or without reason.
9. I agree to hold absolutely confidential all information that I may obtain, directly or indirectly, concerning clients, community members, training procedures and staff. I understand that an intentional or unintentional violation of confidentiality may result in disciplinary action, including termination by JCSH.
Vehicle Terms and Conditions (if applicable):
I understand that I may, at my sole discretion, choose to drive my own vehicle while engaging in volunteer activities and will not hold JCSH responsible for any incidents or accidents while on the road.
I understand that I am under no obligation to drive a client if it was not part of my volunteer agreement.
I agree to send a copy of my Hawaii drivers license and insurance card to JCSH (scan or screen shot and then email) and that I have reasonable accomodations for a passenger.
SIGNATURE:
I understand and agree to the above policies of Jewish Community Services of Hawaii, and know that JCSH is very appreciative of me.