Application Form - Loaves & Fishes Community Services

I acknowledge that I have decided to volunteer with Loaves & Fishes Naperville Community Services (L&F). I acknowledge that I will receive no compensation from L&F for any of my volunteer services. I acknowledge that I am not an employee of L&F and I will not be considered an employee of L&F for any purpose. Furthermore, I acknowledge and understand that my volunteer service for L&F may be ended by me or by L&F at any time and for any reason.

I acknowledge and understand that when volunteering with any organization, including L&F, there are risks associated with volunteering that I will face, including but not limited to personal injury to me or damage to or theft of my property. I further acknowledge and understand that these risks cannot be completely controlled or prevented. By way of example only, possible injuries that could occur during my volunteer service include bodily injury to me caused by lifting, a slip and fall, or harm that may be caused by others.

Accordingly, for good and valuable consideration, including but not limited to the privilege of volunteering with L&F, I hereby agree as follows:

• By signing below I acknowledge that my volunteer services for L&F are entirely voluntary, and I hereby voluntarily assume any and all risks (both known and unknown) associated with my volunteer service for L&F including but not limited to those risks described above.
  
  
• By signing below, I agree on my own behalf and on behalf of my representatives, assigns, heirs and next of kin, to waive, discharge, release and further agree not to sue L&F (and its officers, directors, employees, agents, representatives and volunteers) from any and all responsibility, liability, claims, demands, costs, expenses (including attorneys’ fees) or actions arising out of or relating in any way to my volunteer services with L&F, including, but not limited to, all actions based upon negligence and all claims, for any personal or physical injury or damage to my property, whether occurring on L&F’s premises or otherwise arising in connection with my volunteer services at L&F, except those arising from gross negligence or willful or wanton misconduct.
  
  

I hereby acknowledge that I have been given a reasonable opportunity to read the foregoing waiver and release of claims, and that I have read and fully understand its provisions. By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a volunteer, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal.

PHOTOGRAPHIC/VIDEO RELEASE

I hereby give to Loaves & Fishes Community Services and their legal representatives and assigns:

a) The unrestricted right and permission to copyright and use, re-use, publish, and republish photographic/video portraits or pictures of me or in which I may be included intact or in part, composite or distorted in character or form, without restriction as to changes or transformations in conjunction with my own or a fictitious name, or reproduction hereof in color or otherwise, made through any and all media now or hereafter known for illustration, art, promotion, advertising, trade, or any other purpose whatsoever.

b) I also permit the use of any printed material in connection therewith.

c) I hereby relinquish any right that I may have to examine or approve the completed product or products or the advertising copy or printed matter that may be used in conjunction therewith or the use to which it may be applied.

d) I hereby release, discharge and agree to save harmless Loaves & Fishes Community Services from any liability caused by any blurring, distortion, alteration, optical illusion, or use in composite form whether intentional or otherwise, that may occur or be produced in the taking of said picture/video or in any subsequent processing thereof, as well as any publication thereof, including without limitation any claims for libel or invasion of privacy.

e) I hereby affirm that I am over age 18 and have the right to contract in my own name. I have read the above authorization, release and agreement, prior to its execution; I fully understand the contents thereof. This agreement shall be binding upon me and my heirs, legal representatives and assigns.

INDEMNIFICATION

In addition, I agree to indemnify and hold harmless Loaves & Fishes Community Services and its officers, directors, employees, agents, and volunteers from any claims, liabilities, damages, or expenses arising out of my conduct during volunteer activities, except to the extent caused by the gross negligence or willful or wanton misconduct of Loaves & Fishes.

EMERGENCY MEDICAL AUTHORIZATION

In the event of a medical emergency, I authorize Loaves & Fishes Community Services to seek emergency medical treatment on my behalf if I am unable to do so or cannot be reached in a timely manner. I understand that I am responsible for the cost of any medical care provided.

GOVERNING LAW AND SEVERABILITY

This agreement shall be governed by the laws of the State of Illinois. If any part of this waiver is found to be invalid or unenforceable, the remainder shall remain in full force and effect.