Volunteer Application

Volunteer Registration

Date of Application*

Name of Volunteer Applicant*

Date of Birth*

Address*

Address

Street Address Line 2

CityState

Zip Code

Cell/Mobile*

Email*

Position applying for*

DentistDental HygienistDental AssistantGeneral Volunteer

All Volunteers:

Do you have a current passport?*

YesNo

Have you ever been on a International volunteer mission?*

YesNo

If yes, which Countries and Dates?*

Do you have a fellow volunteer that you prefer to be roommates with?*

YesNo

Parent signature required at the end of the application.

If Yes, what is their name?*

Travel

It is your responsibility to carry all necessary documents when traveling abroad. DORF is not responsible for any supporting documents necessary for your travel needs or other purposes.

Insurance

DORF does not provide you with insurance of any kind. Travel insurance is mandatory, and you must purchase this prior to departing on your trip. You are solely responsible for securing the minimal coverages as set forth in the Volunteer manual, and by evaluating and determining the type, extent and levels of any additional insurance coverage you need or desire for your planned volunteer travel period. However, any travel insurance you select must cover your entire travel period and must include health and emergency medical evacuation coverage.

Refund Policy

All fees paid to DORF as a part of the Uganda volunteer program are deemed to be charitable contributions, and DORF is, therefore, unable to provide a refund of any fees. Registration fees and program fees are not transferable to other persons.

Personal Risks

Personal risks are numerous and include such things as disease, sickness, sexual assault, physical assault, threats, property crimes, and death. To understand the risks you are assuming as a volunteer in Uganda, you agree to read the following two attached publications: (1) “Statistical Report of Crimes against Volunteers” published by the Peace Corps and (2) “Health Information for Travelers to Uganda” published by the U.S. Centers for Disease Control and Prevention.

Furthermore, you acknowledge and accept the responsibilities and risks associated with your agreement to travel to, temporarily live in, and provide volunteer services in Uganda. Once again, this travel and volunteer work can be hazardous and involves a certain degree of risk, and includes inherently dangerous activities and personal perils to you, both foreseen and unforeseen, all of which are fully accepted by and solely assumed by you, the volunteer.

The above two reports and documents can be viewed at:

Health Information for Travelers to Uganda https://www.cdc.gov/travel/destinations/traveler/none/Uganda
Statistical Report of Crimes against Volunteers:
https://files.peacecorps.gov/documents/open-government/2020_Annual_Report_of_Crimes_Against_Volunteers.pdf

Therefore, Dental Outreach Relief Foundation, including any and all of its officers, directors, and volunteers, as well as its host country partner organizations and individuals (collectively “DORF”) are not liable, to the maximum extent of the law, for any loss or harm you may suffer, including but not limited to loss caused directly or indirectly by:

Sexual Assault or Physical Assault
Threats
Property Crimes
Personal injury
Emotional injury
Death, illness or disease
Damage to or loss of property
Hostage situations
War or terrorism.

INITIAL HERE * to acknowledge your agreement to the foregoing Personal Risks

Indemnity

You agree to indemnify, defend and hold harmless, DORF and any and all of DORF’s officers and directors, volunteers, as well as DORF’s host country partner organizations and individuals against any and all liability arising from the foregoing described Personal Risks or which you the Volunteer incurs arising directly or indirectly out of, or in connection (in any way) with your participation as a volunteer in DORF activities, including your travel to and from, living in and providing volunteer services in Uganda.

INITIAL HERE * to acknowledge your agreement to the foregoing Indemnity

Code of Conduct

As a DORF volunteer, you agree to abide by the code of conduct (as presented in your volunteer application and as outlined below) at all times and in all places throughout the entire period of your volunteer experience.

No alcohol*
No illegal drugs*
No profanity
No tobacco*
No marijuana*
No pornography*
No prescription drugs without a prescription*
No vulgar language

*You understand that if you violate any of these details of the volunteer code of conduct you will be removed from the volunteer program and asked to immediately leave the volunteer premises including schools and temporary dormitories, and that you will bear the financial burden associated with such removal, including but not limited to hotel costs, transportation costs, and itinerary change fees.

INITIAL HERE

Photos, Emails and Social Media Posts

For promotional / marketing purposes, do you grant DORF the right to use your communication (e.g., emails, textsmessages and social media posts) and your images (e.g., photos and videos) relating to your experience as a DORF Volunteer?*

YesNo

INITIAL HERE * to acknowledge your consent to grant DORF the right to use your photos emails and social posts as explained above.

Luggage and DORF Supplies

When traveling to Uganda, airlines typically allow you to travel with two 50-pound pieces of checked luggage in addition to your carry-on luggage. You understand that you are required to dedicate one of these two allowed pieces of luggage to transport mission supplies.

INITIAL HERE* to acknowledge your agreement to the Luggage and DORF supplies policy.

Miscellaneous

To the full extent permissible at law, all representations, terms, warranties, guarantees, or conditions whether implied by statute, common law or custom of the trade or otherwise, including, but not limited to, implied warranties and guarantees, are excluded. Notwithstanding anything else contained in any agreement, the liability of DORF to you, the volunteer, shall not in aggregate exceed the amount of the registration fee paid by the volunteer. DORF reserves the right to remove you as a volunteer from the program. DORF has no liability for any lack of performance, unavailability or failure of the services, or for any failure of DORF to comply with these terms and conditions, where the same arises from any cause reasonably beyond the control of DORF.

Governing Law

These terms are governed by the laws of Arizona and Maryland in the United States of America.

Emergency Contact Information

Name*

Relation to you*

Phone*

Email*

By signing below, I acknowledge that I have read the “Statistical Report of Crimes against Volunteers” published by the Peace Corps, that I have read the “Health Information for Travelers to Uganda published by the U.S. Centers for Disease Control and Prevention, that I have NOT been named, charged or convicted of any crime involving sexual abuse, sexual molestation or sexual misconduct as explained above, and that I understand and accept the significant risks associated with being a volunteer in Uganda. By signing below, I further acknowledge that I agree to the Dental Outreach Relief Foundation Terms and Conditions as outlined in this document.

Volunteer’s name*

Volunteer’s signature*

Parent’s name if volunteer is under 18*

Parent’s signature*