Volunteer Waiver

Thank you for volunteering with us!

 

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You only need to complete this form once a year. If you've completed this form in 2018 already, you do not need to do so again.

Participant (Volunteer) Information:

Country*
State / Province*
Address*
City*
*
*
*
*
*
*
Email*
Confirm Email*
Phone
What is your role with Samaritan's Feet?*
  • Donor
  • Event Sponsor
  • Volunteer - Domestic Shoe Distribution
  • Volunteer - Warehouse
What day are you volunteering with us? Please use MM/DD/YYYY format.*
What is the name of the group, business, or church you are representing (if any)?
How would you like to stay engaged with us?*
  • Volunteer at a Domestic Shoe Distribution
  • Become a Monthly Donor
  • Volunteer in the Warehouse
  • Host a Shoe Drive
  • Participate on a Mission Trip
  • Organize a Fundraiser
  • None at This Time
Do you want to receive mail from us?*
  • Yes
  • No

Authorization & Release

I hereby agree and understand:

  1. My participation in Samaritan’s Feet International activities is as a volunteer and not as an employee.
  2. To assume all risks and liabilities that may result from my participation as a volunteer, and to release and forever discharge and hold harmless Samaritan’s Feet International, it’s employees, representatives and agents from any and all actions, causes of action, claims, demands, and liabilities arising out of injury to or damage sustained by me, except to the extent caused by the reckless or intentional actions of Samaritan’s Feet International, its employees, representatives, or agents.
  3. To indemnify Samaritan’s Feet International against any and all liability or loss, and against all claims or actions arising out of damage or injury to persons or property, caused by me.
  4. That as condition of my being a volunteer, I will provide complete medical insurance / coverage for any medical expenses that may be incurred as a result of my volunteer activities.
  5. Any individual listed on a sex and violent offender registry or has been convicted of an offense for which he or she must register as a sex or violent offender may not serve as a volunteer.
  6. MEDIA: In consideration of the use of my likeness, and for other good and valuable consideration herein acknowledged as received, I hereby grant, in perpetuity, to Samaritan’s Feet International, its successors and assigns, exclusive authority and permission as follows:
    • I perpetually and irrevocably give Samaritan’s Feet International., and its subsidiaries, affiliates, licensees, successors, assigns, agents, contractors, and partners, my consent and authorization to use my likeness in any medium and for any purpose whatsoever.  
    • I waive any right to see or approve any recording of my likeness and any materials in which my likeness is used. I agree and understand that my likeness may be modified or distorted and that my own name, a fictitious name, or no name may be used in association with my likeness.  
    • I irrevocably release, discharge, and hold harmless Samaritan’s Feet International, and its subsidiaries, affiliates, licensees, successors, assigns, agents, and contractors from any claims, demands, or causes of action that I may now have or may hereafter have for defamation, slander, libel, invasion of privacy or right of publicity, copyright infringement, or any other right arising out of or relating to the use of my likeness.
CHECKING THE BOXES BELOW SERVES AS YOUR SIGNATURE AND AGREEMENT TO THIS AUTHORIZATION AND RELEASE:*
  • IF THE PARTICIPANT IS 18 YEARS OF AGE OR OLDER: By checking this box, I agree, that I have read this Authorization and Release and fully understand its contents, and that this Authorization and Release shall be binding upon me and my heirs, legal representatives, and assigns.
  • IF THE PARTICIPANT IS UNDER THE AGE OF 18: By checking this box, I warrant that I am the parent or legal guardian of the above named person (the "Participant"), and I irrevocably consent to and authorize all of the foregoing on behalf of Participant and myself.

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