Written Volunteer Engagement Acknowledgement
Congratulations on being selected for a volunteer engagement with The Kidney Foundation of
Canada. Prior to commencing your engagement, please read and sign this acknowledgement form
and return it to (xxx) at (e-mail and fax number here).
Personal Information
Name: 
Full Address: 
Phone: (H): 
E-Mail: 
(B): 
(C): 
Volunteer Engagement
Position & Basic Responsibilities: 
Mentor (person responsible for the volunteer): 
Schedule: 
Duration: 
Acknowledgement of Volunteer Role
You agree and acknowledge that you are assuming a volunteer role at The Kidney Foundation of
Canada and that during the course of this engagement with The Kidney Foundation there does not
exist any employer/employee relationship and that as a volunteer there is no remuneration
associated with this role.
Reimbursement of Out-of-Pocket Expenses
The Kidney Foundation will reimburse reasonable out-of-pocket expenses, upon prior approval of
said expenditures, according to the annual reimbursement policy.
Code of Conduct
During the course of your volunteer engagement you agree to:
 treat all Kidney Foundation stakeholders with respect & dignity;
 contribute to a welcoming and safe working environment free from harassment of any kind;
 become familiar with, and adhere to, Kidney Foundation policies and procedures in link with
your role;
 engage in conduct that reflects favorably upon the character of The Kidney Foundation while
representing same;
 act with honesty and integrity and in accordance with any professional standards and/or
government requirements that apply to the responsibilities performed for, or on behalf of, The
Kidney Foundation;
 disclose any perceived or actual conflict of interest.
By-Laws, Regulations, Policies and Procedures
You will be bound by and will faithfully observe and abide by the By-Laws, Regulations, policies,
positions and procedures of The Kidney Foundation of Canada in force which are brought to your
attention or of which you should reasonably be aware.
Confidentiality Agreement
During the course of your volunteer engagement, you may have privileged access to information
of a confidential nature. Accordingly, you must undertake to treat confidentially all such
information and agree not to disclose same to any third party either during or following your term
of engagement.
Probationary Period
I understand that my volunteer engagement with The Kidney Foundation of Canada shall include a
probationary period and that during this time there will be an orientation program along with an
on-going assessment of my performance in the role.
August 2013
Written Volunteer Engagement Acknowledgement
Release and Consent by Parent/Guardian (for those who are under the age of majority)
I understand that my child or youth (who is under the age of majority) wishes to participate as a
volunteer with The Kidney Foundation of Canada and I hereby give my permission for him/her to
be involved in this activity in support of The Kidney Foundation of Canada.
Name of Volunteer under the age of majority: 
Parent/Guardian’s Name: 
Nature of Relationship: 

Signature of Parent/Guardian
(MM/DD/YY)
Emergency Contact Information
Name: 
Telephone Number: 
Relationship to you: 
Name: 
Telephone Number: 
Relationship to you: 
Release of Liability
I (name of volunteer here) 
agree that I am volunteering at my own request and at my own
risk. I acknowledge that I am aware of all the risks inherent in this role and I certify that I have
not been otherwise informed by any physician and know of no restrictions imposed on me by my
own physician that would in any way prevent me from actively participating in this role.
Further, I, on behalf of myself, my successors in interest, heirs, assigns and representatives,
hereby fully release and agree to hold harmless The Kidney Foundation of Canada, its affiliates,
Officers, Trustees, agents, employees and representatives, successors and assigns, of and from
any liability, claims, damages or causes of action for any reason, even as a result of negligence by
The Kidney Foundation of Canada or that of anyone acting on The Kidney Foundation of Canada’s
behalf including without limiting the generality of the following: death, bodily injury, property
damage, or any other loss, or inconvenience whatsoever, suffered by me at any time hereafter
occurring as a result of my voluntary engagement with The Kidney Foundation of Canada.
Acknowledgement of Understanding
I have carefully read and understood this document and the policies and procedures referred to
herein which have been made available to be on-line and, if requested, in hard copy format.
I understand all of the foregoing and I accept responsibility and accountability for adherence to
same. Further, I am aware that violations of these policies and procedures can lead to disciplinary
action up to and including termination of my volunteer engagement.
I understand and agree that The Kidney Foundation of Canada has the right to amend its policies
and procedures from time to time, in its sole discretion. I agree to promptly review any changes
to policies and procedures which are brought to my attention by The Kidney Foundation.
Accessibility Standard for Customer Service - Accessibility for Ontarians with
Disabilities Act 2005 (Ontario volunteers only – or as/if similar legislation is adopted across the
Country)
I acknowledge that I have carefully read and understood The Kidney Foundation of Canada’s
Policies and Procedures regarding the Accessibility for Ontarians with Disabilities Act (2005) and
have completed the associated training. These standards and laws are applicable to anyone who
represents The Kidney Foundation of Canada and have been made available to me through an
online, hard copy or in-person training session. I accept responsibility and accountability for
adhering to these standards regarding my conduct while representing The Kidney Foundation.

(Signature of Volunteer)
(MM/DD/YY)

(Signature of Witness)
August 2013
(MM/DD/YY)
Written Volunteer Engagement Acknowledgement
If the individual received formal generic AODA training session via a hospital or
other workplace and has the certification to prove it:
Accessibility Standard for Customer Service - Accessibility for Ontarians with
Disabilities Act (2005) (Ontario volunteers only – or as/if similar legislation is adopted across the
Country)
I acknowledge that I have carefully read and understood The Kidney Foundation of Canada’s
Policies and Procedures regarding the Accessibility for Ontarians with Disabilities Act (2005).
These standards and laws are applicable to anyone who represents The Kidney Foundation of
Canada. I acknowledge that I have completed formal Customer Service training through another
institution and have provided proof of this along with my application. I acknowledge that
additional training materials are available to me from The Kidney Foundation of Canada in an
online, hard copy or in-person training session. I accept responsibility and accountability for
adhering to these standards regarding my conduct while representing The Kidney Foundation.

(Signature of Volunteer)
(MM/DD/YY)

(Signature of Witness)
August 2013
(MM/DD/YY)