Volunteer Waiver

Name

First NameLast Name

Phone Number

Area CodePhone Number

Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

School/ Organization

Would you like to receive our monthly newsletter?

In case of emergency, please contact:

Name

Phone

Relationship

Please list any medical conditions (including allergies) that could impair your ability to perform certain tasks or potentially pose a risk to your own safety or the safety of others.

This Release and Waiver of Liability (the "Release") executed by the participant in favor of 716 Ministries, Inc. (DBA Westside Ministries) a non-profit corporation organized and existing under the laws of the State of New York, USA, its directors, officers, employees, volunteers and agents (collectively "716").

I, the Participant, desire to participate with 716 Ministries, Inc. in a construction project, and engage in the activities related to being a participant of any of the events checked below. I understand that the activities may include but are not limited to, walking, constriction, being transported to and from event site locations, consuming food, working in the 716 Ministries, Inc. office or housing properties and other participator related activities. I hereby freely and voluntarily, without duress, execute this Release under the following terms.

Waiver and Release. I, the Participant, release and forever discharge and hold harmless 716 Ministries, Inc. from any claim or liability that I, the Participant, may have against 716 Ministries, Inc. with respect to any bodily injury, personal injury, illness, death or property damage that may result from the paricipation with a construction project. I also understand that 716 Ministries, Inc. does not assume responsibility for or obligation to provide financial assistance or other assistance, including, but not limited to medical, health or disability insurance, in the event of injury, illness, death or property damage (see requirements below).
Insurance. I, the Participant, understand that 716 does not carry or maintain, and expressly disclaims responsibility for providing any health, medical or disability coverage for the Participant.
Medical Treatment. Except as otherwise agreed to by 716 in writing, I hereby release and forever discharge 716 from any claim whatsoever which arises or may hereafter arise on account of any first-aid treatment or other medical services rendered in connection with an emergency during my time with 716.
Assumption of Risk. I understand that my time with 716 may include activities that may be hazardous to me, including, but not limited to, construction activities, loading and unloading of heavy equipment and materials, and local transportation to and from the event sites. So, I recognize and understand that my time with 716 may, in some situations, involve inherently dangerous activities. I hereby expressly and specifically assume the risk of injury or harm in their activities and release 716 from all liability for injury, illness, death or property damage resulting from the activities of my time with 716.
Photographic Release. I hereby grant 716, its legal representatives, successors and assigns, irrevocable permission to take and to copyright, in its own name or otherwise, and re-use, publish and republish photographic portaits, pictures or similar images of likenesses (collectively, the "pictures") of me and my children and/or other minors for which I am legally responsible, including, without limitation, any other pictures in which I or they may be included, in whole or in part, composite or distorted in character or form, without restriction as to changes or alterations, in conjunction with my own or fictitious name(s), or reproductions thereof in color or otherwise, made through any medium, and in any and all media now or hereafter known for illustration, promotion, art, editorial, advertising, trade, and any other purpose whatsoever. I also consent to the use of any published matter in connection therewith. The pictures may be published in any manner, including advertising, periodicals, trade show exhibits and other promotional applications. Furthermore, I will hold harmless 716, its representatives, successors and assigns, from any liability arising from or in connection with the aforementioned pictures.
Other. If there is any violation of this agreement and 716 is sued, or a claim is made against 716, I agree to indemnify 716 Ministries, Inc. and hold them harmless from any and all expense and liability. Such indemnity shall cover all reasonable expenses incurred by them, including, but not limited to attorney fees.

By my eSignature below, I certify that I have read this assumption of risk, release of liability, and release agreement and I fully understand its contents. I am aware that this is a release of liability and a contract between me and 716 Ministries, Inc.

Please signify your acceptance by entering your full name in the box below

eSignature