Thank you for volunteering with Kalamazoo Valley Habitat for Humanity (Habitat). We’re glad you are joining our mission to make affordable homeownership possible in greater Kalamazoo. Before you begin, please read this “Release” form carefully. By signing this release, you will help us stay focused on our mission and create a safe working environment for everyone. If you have any questions, please contact the Community Engagement Coordinator at 269-344-2443, ext. 206. Thanks again for your partnership! Please read carefully before you sign the release. This is a legal document.
RELEASE AND WAIVER: I, the Volunteer, acknowledge and understand that participation in the Activities may involve certain risks, including, but not limited to, personal injury(ies), bodily injury, illness, permanent disability, property damage, loss and/or death (“Risks”). These Risks include, but are not limited to, exposure to and/or infection with COVID-19 and/or other viruses and/or bacterial infections even in ideal conditions, and despite any and all reasonable efforts made to mitigate such Risks. I further acknowledge and agree that, due to the nature of the Activities, social distancing of six feet per person will not always be possible and that my participation in the Activities may result in an elevated risk of contracting COVID-19 and/or other viruses and/or bacterial infection.
I, the Volunteer, further confirm that prior to engaging in the Activities, I may be required to complete a COVID-19 health screening questionnaire provided by Kalamazoo Valley Habitat for Humanity. I agree that I will answer all questions on the questionnaire truthfully. I agree to not participate in any Activities if, at such time and to the best of my knowledge, I am a carrier of COVID-19 or infected with COVID-19. I further agree to follow all safety precautions outlined by Kalamazoo Valley Habitat for Humanity while volunteering.
In consideration of and in order to be allowed to participate in the Activities, I do hereby release and forever discharge and hold harmless Kalamazoo Valley Habitat for Humanity and their successors and assigns from any and all liability, claims, demands, costs and damages of any kind, whether arising from tort, contract or otherwise, which I or my heirs, assigns, next of kin or legal representatives may have or which may hereinafter accrue, arise from, or are in any way related to my Activities with Kalamazoo Valley Habitat for Humanity, including but not limited to Risks, whether caused wholly or in part by the simple negligence, fault or other misconduct of Kalamazoo Valley Habitat for Humanity or of other volunteers, other than their intentional or grossly negligent conduct. In addition, Kalamazoo Valley Habitat for Humanity shall have the benefit of any future liability protection for businesses as relating to the COVID-19 pandemic passed by any governmental entity to which Kalamazoo Valley Habitat for Humanity is subject.
I understand and acknowledge that by signing this Release I knowingly assume the Risks associated with the Activities. I also understand that Kalamazoo Valley Habitat for Humanity does not assume any 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. Regarding any illness or virus, including COVID-19, I, the Volunteer, understand that even if I follow all guidelines for the prevention and handling of any illness or virus, including COVID-19, there is still a risk that Volunteer could contract such virus or illness.
I understand and acknowledge that children under the age of 16 are not allowed on Habitat for Humanity worksites while construction is in progress. While minors between the ages of 16 and 18 may be allowed to participate in some types of build site activities, solely as outlined by the Released Parties, I understand that using power tools, excavation, demolition, working on rooftops and similar activities are not permitted for anyone under the age of 18. I agree it is my responsibility to communicate these requirements to any of my minor children who will attend and/or participate in the Activities.
Consent to Transportation and Medical Treatment. I consent to the use of first aid treatment and the use of generic and over-the-counter medications and treatments as directed by manufacturer labels, whether administered by Kalamazoo Valley Habitat for Humanity or first aid personnel. In an emergency, I understand Kalamazoo Valley Habitat for Humanity may try to contact the individual listed below as an emergency contact. If an emergency contact cannot be reached promptly, I hereby authorize Kalamazoo Valley Habitat for Humanity to act as an agent for me to consent to any examination, testing, x-rays, medical, dental or surgical treatment for me as advised by a physician, dentist or other health care provider. This includes, but is not limited to, my assessment, evaluation, medical care and treatment, anesthesia, hospitalization, or other health care treatment or procedure as advised by a physician, dentist or other health care provider. I also authorize Kalamazoo Valley Habitat for Humanity to arrange for transportation of me as deemed necessary and appropriate in their discretion. I, the Volunteer, do hereby release, forever discharge and hold harmless Kalamazoo Valley Habitat for Humanity from any liability, claim, demand, and action whatsoever brought by me or on my behalf which arises or may hereafter arise on account of any transportation, first aid, assessment, care, treatment, response or service rendered in connection with my Activities with Kalamazoo Valley Habitat for Humanity.
If the Volunteer is less than 18 years of age, the parent(s) having legal custody and/or the legal guardian(s) of the Volunteer also hereby release, forever discharge and hold harmless Kalamazoo Valley Habitat for Humanity any liability, claim, demand and action whatsoever brought by such volunteer or on his/her behalf which arises or may hereafter arise on account of the decision by any representative or agent of Kalamazoo Valley Habitat for Humanity to exercise the power to transport, administer first aid, and consent to assessment, examination, x-rays, medical, dental, surgical or other such health care treatment as set forth in the Parental Authorization for Treatment of, and Travel With, a Minor Child.
Insurance. I understand that, except as otherwise agreed to by Kalamazoo Valley Habitat for Humanity in writing, Kalamazoo Valley Habitat for Humanity is under no obligation to provide, carry or maintain health, medical, travel, disability or other insurance coverage for any Volunteer. Each Volunteer is expected and encouraged to obtain his or her own health, medical, travel, disability or other insurance coverage.
I understand that I am and remain responsible for payment of such hospital, physician, ambulance, dental, medical or other services obtained for me or my child. I agree that Kalamazoo Valley Habitat for Humanity does not assume any responsibility for the payment of such fees or expenses which may be incurred. If I have health insurance, I understand my personal health insurance is my primary coverage.
Confidentiality. I agree that in the course of my participation in the Activities, I may have access to personal and/or health care information of other persons. I agree to maintain the confidentiality of such information, to use such information only as necessary to do my job as a volunteer, and to comply with Habitat for applicable policies regarding such information.
Photographic/Recording Release. I hereby grant and convey unto Kalamazoo Valley Habitat for Humanity all right, title and interest in any and all photographs and video/audio/electronic recordings of me, including as to my name, image and voice, made by or on behalf of Kalamazoo Valley Habitat for Humanity during my Activities with Habitat, including, but not limited to, the right to use such materials for any purpose and to any royalties, proceeds or other benefits derived from them. I understand that I will not have any ownership interest in or to such photographs, images and/or recordings, I have not been provided or promised any compensation to me, and I hereby waive any rights, privileges or claims based on any right of publicity, privacy, ownership or any other rights arising, relating to or resulting from the photographs, images and/or recordings. I understand and agree that this paragraph also applies to my minor child(ren) who are volunteering.
Other. I expressly agree that this Release is intended to be as broad and inclusive as permitted by state law. I further agree that in the event any clause or provision of this Release is held invalid by any court of competent jurisdiction, the invalidity of such clause or provision shall not otherwise affect the remaining clauses or provisions of this Release, which shall continue to be enforceable. Further, a waiver of a right under this Release by Kalamazoo Valley Habitat for Humanity does not prevent the exercise of any other right.
I have carefully considered my decision, the benefits and risks involved, and hereby give my informed consent to participate in all volunteer Activities. I have read and understand this Release and Waiver of Liability, I acknowledge that any questions of mine have been answered, and I voluntarily agree to the above provisions. It is my intent to bind my heirs, next of kin, assigns and legal representative.
Background Check Consent Kalamazoo Valley Habitat for Humanity has adopted a safety policy requiring all volunteers to submit to a criminal/sex offender background check as part of the overall screening process. This information is collected to ensure a positive and safe environment for all activities.
Your authorization is required to start this process. All results will be kept confidential and will be shared with you upon request by the Community Engagement Coordinator. You will have an opportunity to challenge any negative results or findings.
Failure to sign and/or return this statement will result in your elimination from consideration to join Kalamazoo Valley Habitat for Humanity as a volunteer. Your efforts to join us in ensuring safety are greatly appreciated.
I understand that a criminal and sex offender background check is required in order to serve as a volunteer. I authorize the appropriate department to conduct a background check.
I further state that I have carefully read the foregoing release, know its contents and sign as my own free act.