VOLUNTEER WAIVER AND RELEASE FORM

VOLUNTEER WAIVER AND RELEASE FORM 2017-05-08T08:39:29+00:00

VOLUNTEER WAIVER AND RELEASE

VOLUNTEER WAIVER AND RELEASE


HistoriCorps conducts a “hands-on” field program in historic preservation, which undertakes rehabilitation projects on buildings situated on publicly accessible lands around the country using a largely volunteer workforce.

Since participation in such projects necessarily entails a variety of risks and dangers, as an express condition to participating as a volunteer in a HistoriCorps project, individuals are required to review and agree to this Waiver and Release. Individuals must sign this form for each project in which they participate. Therefore, in consideration for being allowed to participate in the HistoriCorps project identified below, the undersigned (“Volunteer”), acknowledges and agrees as follows:

  1. While HistoriCorps and its employees endeavor to take all reasonable cautions to avoid exposing Volunteers to anything that presents an undue risk of injury or illness, just given the nature of HistoriCorps projects, it is possible that Volunteers may nevertheless be exposed to:
  • Construction-related hazards, including without limitation loud noises, dust, sharp tools, heights, and the need to move heavy and/or awkward loads;
  • Environmental hazards such as exposure to mold, asbestos, or other substances that may have been used in the construction of the structure being rehabilitated or have developed since the structure was built;
  • Natural hazards such as wild animals, mosquitoes, ticks or other parasites, rodent-borne diseases, and harmful flora such as poison ivy or poison oak;
  • Weather-related hazards, such as heat, cold, wind, snow, elevation, ice, rain that may make working conditions more difficult.
  1. While Volunteers are covered by HistoriCorps’ volunteer accident policy for injuries sustained during the project, it is possible that this insurance may not cover all of the costs associated with any illness or injury incurred as a result of participation in the project.
  1. Volunteer expressly acknowledges that the activities associated with a HistoriCorps project contain inherent elements of hazard and risk and that Volunteer could be seriously injured or even killed or develop a serious illness as a result of participating in this project. I am voluntarily participating in these activities with the understanding and appreciation that participation in the project carries with it these sorts of risks and dangers and hereby agree to assume any and all risks of bodily injury, death, or property damage, whether such risks or dangers are presently known or unknown.
  1. Volunteer hereby releases, discharges and covenants not to sue HistoriCorps or any of its directors, officers, members, agents, employees, successors and/or assigns (collectively, “Releasees”) from and with respect to any and all claims, damages, suits, liabilities and other obligations, including, without limitation, claims or damages for bodily injury, death, illness, or property damage, that are suffered or incurred by Volunteer, while or as a consequence, direct or indirect, of participating in the HistoriCorps project, except for any such claims that arise solely out of the gross negligence or willful misconduct of HistoriCorps or any of its employees. Volunteer hereby waives any such claim that the undersigned may have, now or hereafter, in association with my participation in the HistoriCorps project.
  1. Volunteer hereby consents to the use by HistoriCorps for any purpose (including without limitation, inclusion on any HistoriCorps brochure or website) of any photo or other images taken of me while I am engaged on the Project. I understand that I shall not be entitled to receive compensation for any such use of my image by HistoriCorps.

This Waiver and Release shall bind the undersigned and the undersigned’s heirs, personal representatives, executors, successors, and assigns and shall inure to the benefit of HistoriCorps and the other Releases. This Release shall be governed by and construed in accordance with the laws of the State of Colorado.

Signed: (NOTE: if volunteer is under the age of 18, a parent or legal guardian must sign on behalf of the volunteer)

Print Name:

Volunteer Date of Birth:

Volunteer Email:

Volunteer Phone Number:

Volunteer Address:

Name of One Emergency Contact:

Phone Number of One Emergency Contact:

Project Name:

Project Dates:

Today's Date:

Leave this empty:

Signature Certificate
Document name: VOLUNTEER WAIVER AND RELEASE
Unique Document ID: bb159614ac40128ba9117f6e91f39095678dec5e
Timestamp Audit
2017-01-25 11:53:15 MSTVOLUNTEER WAIVER AND RELEASE Uploaded by Liz Rice - lrice@historicorps.org IP 174.51.59.108

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