VOLUNTEER DECLARATION, AGREEMENT, RELEASE and CONSENT (The Release and Consent )
VOLUNTEER DECLARATION, AGREEMENT, RELEASE AND CONSENT (the “Release and Consent”)
The undersigned, , has applied to The Olive Branch for Children (“The Olive Branch”) to be accepted as, and for permission to work with The Olive Branch and its personnel as, a volunteer (a “Volunteer”) in Tanzania, assisting The Olive Branch in its activities and projects in Tanzania.
In consideration of The Olive Branch’s accepting me as a Volunteer, I, on behalf of myself and my heirs, personal representatives, administrators, executors, next-of-kin, estates, insurers, assigns, and anyone else who may make any claim for or on behalf of myself, am irrevocably and unconditionally submitting this Release and Consent to The Olive Branch with the full understanding that it will be relied upon to determine whether The Olive Branch will accept my application to be a Volunteer.
- I hereby declare that I have been informed about, have considered and fully understand the nature of The Olive Branch’s undertakings and projects in Tanzania and the responsibilities and risks I am undertaking in becoming a Volunteer.
(Answer “yes” or “no”: ______and write your initials: ( )
- I hereby declare that I have fully appreciate that there are certain risks to which I and my personal property will be exposed as a Volunteer including the risk of personal injury and property theft, loss and damage arising in the course of my traveling to and from Tanzania and traveling to and from The Olive Branch’s location(s) in Tanzania and being a Volunteer and participating in The Olive Branch’s undertakings in Tanzania and that I am fully prepared to voluntarily undertake that travel and that I accept those risks.
(Answer “yes” or “no”: ______and write your initials: ( )
3. I have disclosed to The Olive Branch any health condition or s which affect or could affect me or from which I suffer and which may affect my ability to do the work in which I will be involved as a Volunteer. I further declare that I have not engaged in any fraud or deception in applying to be a Volunteer.
(Answer “yes” or “no”: ______and write your initials: ( )
- I understand and acknowledge that neither The Olive Branch nor any of its officers, directors or employees have arranged for or carry any insurance of any kind for my benefit or that of my heirs, executors and administrators relative to or in respect of my being a Volunteer, and any travel related thereto, and that I am solely responsible for obtaining and paying any life, health, travel, hospital, accident, property or other insurance relative to my being a Volunteer. Furthermore, I understand that I must possess certain travel documents and have certain inoculations in connection with becoming a Volunteer and traveling to and from Tanzania and that I alone am responsible for obtaining all such documents and inoculations, at my sole expense, and ensuring that the documents and inoculations will permit me to complete my travel and my stay in Tanzania as a Volunteer.
(Answer “yes” or “no”: ______and write your initials: ( )
- I understand and acknowledge and, hereby for myself, my heirs, executors and administrators, do fully release and agree to hold The Olive Branch and each of its directors officers, employees, representatives, and agents (collectively, the “Releasees”) harmless from and against any and all costs, injuries, losses or damages of any kind, including, without limitation, death, bodily injury, and property or other damages or losses, due in whole or in part, directly or indirectly, to my becoming or being a Volunteer, or to my participating in any activities or work related thereto, or due in whole or part to my undertaking the travel related to my being a Volunteer including, without limitation, my travel to, within and returning back from Tanzania. I further hereby agree to be personally responsible for the cost of all travel to and from Tanzania in connection with my becoming a Volunteer, except such cost as The Olive Branch expressly has agreed in writing to pay for. I agree that this release of liability and indemnity shall be binding upon me and upon my assigns, heirs, executors and administrators and shall enure to the benefit of each of the heirs, executors, administrators, successors and assigns of the Releasees.
(Answer “yes” or “no”: ______and write your initials: ( )
- I agree to pay to The Olive Branch all fees, costs or expenses owed or owing to The Olive Branch in connection with my becoming a Volunteer, in full and promptly when same become payable. I further agree to comply in full and promptly with all instructions given me and requests made of me by The Olive Branch’s director in Tanzania in connection with my activities as a Volunteer.
(Answer “yes” or “no”: ______and write your initials: ( )
- If I am accepted by The Olive Branch to be a Volunteer, I hereby grant to The Olive Branch the right, but not the obligation, to use my name, voice, photograph and likeness, along with my address (city/town, Province/State
and country) and any statements made by or attributed to me in any and all media now known or hereafter devised (including, without limitation, print, broadcast and the Internet), without notice, review or approval, in perpetuity and throughout the universe for promotional and informational purposes in connection with The Olive Branch and its activities and undertakings and I release The Olive Branch from any liability with respect thereto.
(Answer “yes” or “no”: ______and write your initials: ( )
- I agree that the acceptance by The Olive Branch of my application to be a Volunteer is being based, in part, on the above information. I further agree that if any statement made by me in this Release and Consent is false or misleading, I will indemnify The Olive Branch from any resultant costs, expenses or damages it may suffer.
(Answer “yes” or “no”: ______and write your initials: ( )
- I declare that my signature below represents that I have read, understood, and am in agreement with all of the information and statements above and acknowledge that the initials appearing next to the information are mine. I further understand that the information I have provided above is subject to further verification prior to my being accepted as a Volunteer.
(Answer “yes” or “no”: ______and write your initials: ( )
My Signature Below Represents That I Have Read, Understand, And Am In Agreement With All The Information, Agreements And Statements Above.
Potential Volunteer’s Full Legal Signature:
______
______
Witness’s Name: (Please Print)______
Witness’s Signature:
______
Date: ______
The Olive Branch For Children,
O/S Ginette McCracken,
14-3650 Langstaff Rd., Suite # 377,
Woodbridge, Ontario. Canada
Tel: 905-264-9385 Fax: 905-850-5651
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