I certify that the information I enter on this application is complete, accurate and truthful.
I represent that I have no record of criminal conduct involving violence or harm to other persons, larceny or sale or distribution of illegal drugs.
I agree to indemnify, defend and hold harmless the DVA its respective agents, staff and employees from any and all claims, damages, liabilities, costs and expenses including without limitation, reasonable attorney’s fees, arising out of, or caused by my negligent acts or omissions while on or off the DVA’s Campus while I am providing volunteer services to the DVA.
I agree that I will not hold the DVA or the State of Connecticut responsible for any claims or injuries caused by any DVA Veteran Resident or Patient that may arise out of my volunteering at DVA.
I understand and acknowledge that at no time, except as necessary in the official performance of my volunteer duties, shall I disclose any protected health information of DVA’s Veteran Residents or Patients, as defined by the HIPAA Privacy Rule (42 C.F.R. Parts 160 and 164) of the Health Insurance Portability and Accountability Act of 1996, as amended. I further understand and acknowledge that at no time, except as necessary in the official performance of my volunteer duties, shall I disclose any financial, personally identifying or other sensitive information of DVA Veteran Residents or Patients.
I agree to abide by all regulations, rules and policies of the DVA including, but not limited to, the prohibition on the possession or consumption of alcohol, illegal drugs and possession of any firearms or dangerous weapons.
I acknowledge that in providing these voluntary services I am not an employee or contractor of the State of Connecticut and not entitled to any benefit or protections afforded state employees or contractors and that I will only accept remuneration in the form of voluntary gratuities.