Agreement & Confidentiality Acknowledgment Form
We are pleased you have decided to volunteer your services to Dynamic Image Inc., the mandatory understanding concerning your voluntary work is as follows:
1. You agree that your participation is entirely voluntary and you are not considered a Dynamic Image Employee.
2. You are eighteen years of age or older. Minors need parental permission.
3. You, on behalf of yourself, your agents, heirs, representatives, executors or administrators, her by release, indemnify and hold harmless Dynamic Image from an and all liability damage, claim of any nature whatsoever arising out of or in any way related to your volunteer duties. Thurs, Dynamic Image bears no responsibility in case of an accident or health problem with you may encounter as a result of activities carried out in connection with your volunteer activity or otherwise.
4. You understand that Dynamic Image does not provide any accident or medical insurance and that you are required to provide your own accident and medical insurance. You hereby agree that you are financially responsible for all such expenses. You are not covered by employee benefits or by worker’s compensation.
5. You understand that all volunteers are subject to Dynamic Image regulations, laws which is considered to be detrimental to staff, or the program, Dynamic image shall have the right to dismiss you as a volunteer without prior notice. You do not have a form appointment at Dynamic Image
Please initial to indicate authorization:
____ I certify that all the information provided in this application is true and complete. I understand that falsification or omissions of any information may be caused for denial of appointment or dismissal if discovered at a later date.
____ I understand that this is an application for and not a commitment or promise of volunteer opportunity.
____ I understand that prior to the expiration of my term, if appointed, I am subject to suspension and removal by Dynamic Image at any time.
____ I understand that there will be media, video and photography usage at all events and may be used for public or marketing use for Dynamic Image.
Dynamic Image Statement. It is the policy of Dynamic image that ll persons shall have equal opportunity and access it its programs and facilities. Dynamic Image is committed to providing an environment that is free from discrimination in employment and opportunity because of race, color, religion, creed, national origin, ancestry, disability, gender, sexual orientation, or age.
CONFIDENTIALITY STATEMENT: In signing this form, I understand that I have a professional responsibility to maintain the confidentiality of consumers served by Dynamic Image. Confidentiality included not discussing consumer names and other information with those not involved in service with Dynamic Image. Consumer records are confidential and information these records cannot be shared except as required by law, without the written consent of the consumer, family, or other legally responsible parties. The written or verbal release of information much comply with Dynamic Image policy and procedure regarding confidentiality and release of information. The misuse of this knowledge can be damaging to the consumer, his/her family, and to the professional and public image of Dynamic Image. I understand and accept my obligation in this respect.