VOLUNTEER LIABILITY WAIVER AND RELEASE
PLEASE READ THIS AGREEMENT CAREFULLY. IT IS A LEGAL DOCUMENT THAT
AFFECTS YOUR RIGHTS
I, on behalf of myself, my personal representatives, heirs and next of kin, hereby voluntarily and forever,
to the fullest extent permissible under law, waive and agree to release, defend and indemnify City of
Refuge, Inc. and its members, officers, directors, employees, contractors, representatives, successors and
assigns from any and all actions, claims or losses, whether known or unknown, anticipated or
unanticipated, that might arise out of or in connection with the services provided by City of Refuge, Inc.
Parties or my volunteering with City of Refuge, Inc. whether such Claims are based on negligence, strict
liability, breach of warranty, contract or otherwise. Notwithstanding the foregoing, no party shall be
required to indemnify City of Refuge, Inc. Parties for Claims arising out of the sole negligence of
City of Refuge, Inc. or the City of Refuge, Inc. Parties.
I recognize that, as a volunteer I represent City of Refuge, Inc. to the public. I accept the responsibility for
this status and will conduct myself in a professional manner. I will not be under the influence of any
illegal narcotics or alcohol when conducting business as a representative of City of Refuge, Inc. I will not
participate in and will report any and all instances of any sort of harassment, exploitation, and or
intimidation. I will work to maintain an atmosphere of physical and emotional safety for everyone
associated with the City of Refuge, Inc.
I agree to maintain the confidentiality of all volunteers, clients, and donors whom I have personal and
identifying information. Please initial here: _____
I agree to honor the commitment length and frequency of service that I make to City of Refuge, Inc. I
agree to provide as much advance notice as is possible in the event that I will be absent from my volunteer
shift. I agree to update my personal information and emergency information as changes occur.
Please initial here: _____
I am aware that as a volunteer I expose myself to potential hazards which include but are not limited to:
kitchen accidents, cuts, burns, back injury from lifting, car accidents, property damage or injury to others
in car accidents, falls, thefts, etc. Potential hazards have been explained to me. I am voluntarily
participating in this service with the knowledge of the potential hazards involved and hereby agree to
accept any and all risks of injury. I further release City of Refuge, Inc. from all liability for injury or loss
related to my volunteer service. Please initial here: _____
If my volunteer service includes driving an automobile, I acknowledge that I have both a valid driver’s
license and automobile liability insurance policy as required by the laws of the State of Georgia. I agree to
maintain my license and insurance in good standing for my entire tenure as a volunteer for the
organization. I am knowledgeable of and agree to abide by local and state traffic laws. I agree not to
drive while under the influence of alcohol and/or other intoxicating substances.
Please initial here: _____
I understand and agree to abide by the instructions and regulations of City of Refuge, Inc.
In the event that any portion of this agreement is held to be invalid or unenforceable, the validity or
enforceability of the remainder of this agreement shall be unaffected and shall remain valid and
enforceable to the full extent permissible under law.
This agreement and any disputes arising under or in connection with this agreement, the services provided
by the City of Refuge, Inc. Parties shall be governed by the laws of the State of Georgia. I hereby submit
to the exclusive jurisdiction of the State and Federal courts of the State of Georgia for the settlement of all
Disputes.
I hereby certify that I have read and understand this agreement, that I signed it without duress and
of my own free will, and that I intend to be legally bound by its terms.
Name (PLEASE PRINT)
___________________________
CONTACT INFORMATION:
Please print legibly
Home Address:
Signature
Email:________________________
___________________________
Phone:
Date: ______________________
Name of Place of Work or Affiliation:
FOR THE PARENT OR LEGAL
GUARDIAN OF A PARTICIPANT
Thank you!
I certify that I am the Participant’s parent or legal guardian, or that I otherwise have the legal
authority to represent the Participant and act on her behalf. I have read and understood this
agreement. I hereby consent to and ratify this agreement and agree, on behalf of myself, the
Participant, and each of our respective personal representatives, heirs and next of kin, to be bound
by its terms.
Name (PLEASE PRINT)
___________________________
Signature
___________________________
Relationship to Participant
___________________________
Date: ______________________