UNIVERSITY OF NEBRASKA MEDICAL CENTER
MUNROE-MEYER INSTITUTE
VOLUNTEER NON-CLINICAL FACULTY
AGREEMENT AND RELEASE FORM
This Agreement is made and entered into this
day of
, 20
, by and between the BOARD OF REGENTS OF
THE UNIVERSITY OF NEBRASKA, a public body corporate, for and on behalf of the University of Nebraska Medical Center,
hereinafter called "UNMC" and,
hereinafter called "Volunteer".
1. Volunteer agrees that she/he is volunteering solely for personal, civil, charitable or humanitarian purposes without
promise or expectation of compensation, benefits or future employment from the UNMC. Volunteer understands that
his/her relationship with the UNMC carries with it no promise of continuation and can be terminated in accordance with
the BOARD OF REGENTS OF THE UNIVERSITY OF NEBRASKA Bylaws (Bylaws) and the BOARD OF REGENTS
OF THE UNIVERSITY OF NEBRASKA Policies (Policies). Volunteer acknowledges that she/he has been informed of
the aforementioned Bylaws and Policies. Bylaws can be found at www.nebraska.edu/board/board_bylaws.shtml.
Policies can be found at www.nebraska.edu/board/board_policies.shtml).
2. The professional staff appointment status of Volunteer shall be a Special Appointment at the rank of Adjunct 'enter
rank' in the Department of
. The term of Volunteer’s Special Appointment shall begin on
, 20
, and is
subject to Section 4.4.1 of the Bylaws.
3. Volunteer agrees to perform the teaching, service, and research duties and responsibilities set forth in the written
statement attached to this Agreement as Appendix “A” and incorporated herein by reference. Volunteer and UNMC
agree that Appendix A shall be periodically reviewed and revised as appropriate in accordance with the Bylaws.
4. Volunteer understands that she/he may be subject to criminal background checks or other prescreening checks, if
applicable.
5. Volunteer acknowledges that she/he is not a paid employee of the UNMC, and is not entitled to and will not receive
salary, benefits or any other direct or indirect compensation. Volunteer understands that she/he does not qualify for
worker’s compensation or unemployment compensation or any other benefits through UNMC, and he/she is expected
to have personal medical insurance to cover medical expenses for any injury she/he may incur while performing
services voluntarily for the UNMC.
6. If Volunteer is not a citizen or permanent resident of the United States, Volunteer certifies that she/he has appropriate
visa status that authorizes Volunteer to be present in the United States and allows Volunteer to participate in this
volunteer experience.
7. This Agreement shall be construed and enforced in accordance with, and is subject to the Bylaws and Policies as well
as the laws of the State of Nebraska.
8. The parties agree that this is the entire Agreement between them and that no Agreement, either oral or written, exists
outside this Agreement regarding the volunteer services described in this Agreement.
MMI Volunteer Non-Clinical Faculty Agreement
Agreement and Release (1-21-13)
Faculty Initials __________
Page 1 of 2
VOLUNTEER RELEASE
You acknowledge that your attendance or participation as a volunteer faculty member could cause injury
to you. In consideration for your participation as a volunteer, you hereby assume all risks of injury which
may result from or arise out of your volunteer attendance; and you agree, on behalf of yourself and your
heirs, executors, administrators, and assigns to fully and forever release and discharge the Board of
Regents of the University of Nebraska and the University of Nebraska Medical Center (UNMC) and its
affiliates and their respective officers, directors, employees, agents, successors and assigns, and each of
them (collectively the “Releasees”) from any and all claims, damages, rights of action or causes of action,
present or future, known or unknown, anticipated or unanticipated, resulting from or arising out of your
volunteer services activities including without limitation any claims, damages, demands, rights of action
or causes of action resulting from or arising out of the negligence of the Releasees. Further, you hereby
agree to waive any and all such claims, damages, demands, rights of action or causes of action. Finally,
you agree to release and discharge the Releasees from any and all liability for any loss or theft of, or
damage to, personal property.
IN WITNESS WHEREOF, the parties have executed this Agreement on the dates indicated below.
ACCEPTED:
By: ______________________________________ this _______ day of _____________, 20____.
Faculty Member
APPROVED:
By: ________________________________ ________
Date
Discipline Director
By: ________________________________ ________
Director, Munroe-Meyer Institute
Date
THE BOARD OF REGENTS OF THE
UNIVERSITY OF NEBRASKA
By: ________________________________ _________
Vice Chancellor for Academic Affairs
Date
UNMC
Attachment: Appendix “A”
MMI Volunteer Non-Clinical Faculty Agreement
Agreement and Release (1-21-13)
Faculty Initials __________
Page 2 of 2