Urban Ministries of Wake County, Inc.
Volunteer/Participant Release and Confidentiality Form
RELEASE OF LIABILITY:
In consideration of Urban Ministries of Wake County, Inc. accepting me as a volunteer, I hereby agree to indemnify, defend
and hold harmless Urban Ministries of Wake County, Inc., its employees, or directors for any damages, loss or injuries I may sustain
during my volunteer activities. I acknowledge and understand that as a volunteer, I am not covered by Urban Ministries of Wake
County, Inc.’s Workers Compensation or any other insurance policy for any damages or injuries I may sustain during my volunteer
activities.
USE OF PERSONAL VEHICLES:
I acknowledge and understand that any volunteers, employees, clients, or persons otherwise associated with Urban Ministries
of Wake County, Inc. may not be transported in my vehicle or any other personal vehicles. I understand and acknowledge that noncompliance with this rule could result in dismissal of my services.
CONFIDENTIALITY:
By reason of job duties, volunteers may come into possession of information or have knowledge of information concerning
services performed, even though they may not take any direct part in or furnish the services performed for patients or clients. The
services Urban Ministries of Wake County, Inc. performs for its patients and its clients are confidential. Urban Ministries of Wake
County, Inc. has both a legal and ethical obligation to protect sensitive client and patient-related data in the delivery of services.
I understand that as a volunteer at Urban Ministries of Wake County, Inc. I will be exposed to many types of confidential
information, such as patient services and diagnoses, client information, financial data, employees and operations information. This
information may be accessed through traditional paper files, online, or through a networked computer; regardless of the method, the
requirement for protecting this data remains the same.
Except as directed by organizational or departmental policy and/or practice, volunteers may not at any time disclose any such
services or information to any person whatsoever or permit any person whatsoever to examine or make copies of reports or documents
that have in any way to do with the clients, patients, employees, financial information or operations of Urban Ministries of Wake
County, Inc. Volunteers may not seek any confidential information concerning clients, patients, employees, financial information or
operations except as required in the performance of their duties. In instances where information is stored electronically, volunteers
will be provided with an appropriate user ID and password to access the appropriate level of information. The disclosure of
confidential information, or the pursuit of confidential information which is not required in the performance of a job, may cause
irreparable injury to the client, patient, employee or organization. Disciplinary action, up to and including discharge, and/or legal
remedies may be sought against any volunteer who violates this confidentiality policy. If I am uncertain about the confidentiality of a
matter, I understand that I may discuss the issue with my program director or Human Resources for clarification.
I have read and understand this volunteer release and confidentiality form. I agree that I will comply with the policies
outlined here at all times during my tenure as a volunteer with Urban Ministries of Wake County, Inc.
Parents or guardians must sign if applicant is UNDER 18.
Signature:______________________________ Print Name:__________________________
Name of minor, if applicable:_________________________________________________
Date:_______________________________
Emergency daytime phone number:__________________________________________
Urban Ministries of Wake County
Anti-Discrimination and Harassment Policy
It is the policy of Urban Ministries of Wake County to provide volunteer opportunities at all times without discrimination on the
basis of race, color, religion, sex, sexual orientation, national origin, qualified disability, age (40 years of age or older), veteran status
or other characteristic or activity protected by federal, state or local law. In addition, harassment of volunteers by Agency employees
including co-workers, supervisors, managers and executives, as well as any non-employees based on race, color, religion, sex, sexual
orientation, national origin, qualified disability, age (40 years of age or older), veteran status or other characteristic or activity
protected by federal, state or local law is unacceptable conduct, which will not be tolerated.
1. General Policy Statement on Harassment
Urban Ministries of Wake County believes that all volunteers are entitled to work in an environment free from harassment,
intimidation and coercion, allowing each volunteer to reach his/her full potential. This policy applies to harassment by any
Agency employees, including co-workers, supervisors, managers and executives, as well as any non-employees present in
Urban Ministries’ workplace or interacting with Urban Ministries’ employees in connection with their work. Such prohibited
harassment can arise from a broad range of physical or verbal behavior, which may include, but is not limited to, the
following:
a. Physical or mental abuse;
b. Insults, jokes, slurs or comments based on an individual’s race, color, religion, sex, sexual orientation, national
origin, qualified disability, age (40 years of age or older), veteran status or other characteristic or activity protected
by federal, state or local laws; or
c. Display of suggestive, offensive or discrimination-oriented pictures or materials.
2. Sexual Harassment
Sexual harassment is a specific form of illegal harassment that requires more explanation. Urban Ministries bases its
definition of sexual harassment on information provided by the Equal Employment Opportunity Commission (EEOC).
According to EEOC guidelines, sexual harassment includes, but is not necessarily limited to, unwelcome sexual advances,
requests for sexual favors and other verbal or physical conduct of a sexual nature when:
a. Submission to or rejection of such conduct explicitly or implicitly affects an individual’s volunteering;
b. Submission to or rejection of such conduct by an individual is used as the basis for volunteer decisions affecting
such individual; or
c. Such conduct unreasonably interferes with an individual’ work performance or creates an intimidating, hostile
or offensive work environment.
d. Sexual harassment can occur in a variety of circumstances, including but not limited to, the following:
i.
The victim as well as the harasser may be a woman or man. The victim does not have to be of the
opposite sex.
ii.
The harasser can be the victim’s supervisor, an agent of the employer, a supervisor in another area, a
co-volunteer or a non-employee.
iii.
The victim does not have to be the person harassed, but could be anyone affected by the offensive
conduct.
iv.
Unlawful sexual harassment may occur without economic injury to or discharge of the victim.
v.
The harasser’s conduct must be unwelcome.
3. Complaint Procedure
It is the shared obligation of all employees to report any and all incidents of suspected harassment to the Executive Director.
Any volunteer who believes he or she has been subjected to unlawful harassment, or who believes he or she has witnessed
one or more incidents of unlawful harassment, should immediately report the incident or incidents to his or her immediate
supervisor, or, alternatively, to any other supervisor, and to the Executive Director.
Acknowledgement of Harassment Policy
I have received a copy of Urban Ministries of Wake County’s Harassment Policy. I agree that I will report any and all
incidents of harassment, of which I am aware, to my supervisor, or, alternatively, to any other supervisor and to the Executive
Director. I understand that if I feel that it is necessary or justified by circumstances, I should report the harassment or any retaliatory
action to the Executive Director. I understand that nay violation of the Harassment Policy may be grounds for disciplinary action up
to and including termination.
I WILL ABIDE BY THE RULES AND POLICIES SET FORTH IN THIS DOCUMENT
_____________________________________
Volunteer’s Printed Name
____________________________________
Volunteer’s Signature
___________
Date