Assumption of Risk & Waiver of Liability

I acknowledge that I have voluntarily applied to the Damien Center’s volunteer program. I understand that the scope of my volunteer relationship with the Damien Center is limited to a volunteer position and that no compensation is expected in return for services provided by me; that the Damien Center will not provide any benefits traditionally associated with employment; and that I am responsible for my own insurance coverage in the event of illness or personal injury as a result of my services to the Damien Center.

 

I understand that my volunteer activities with Damien Center may include activities that could be hazardous to me, including but not limited to packing, loading, unloading and carrying heavy items, the actions of clients, and exposure to people with infectious diseases. I fully understand and appreciate the risks that are inherent to my volunteer activities. I hereby assume the risk of bodily injury, illness, death, medical treatment resulting from my volunteer activities even if resulting from the negligence of Damien Center, its employees, board members, volunteers, or clients.

 

I hereby release, discharge and agree to indemnify and hold the Damien Center harmless from, and waive on behalf of myself, any and all causes of action, claims, demands, damage, costs, expenses and compensation or loss to myself that may be caused by any act, or failure to act of the Damien Center, or that may otherwise arise in any way in connection with any voluntary activities with, or for the Damien Center.

 

I understand that this release discharges Damien Center from any liability or claim that I am responsible for may have against Damien Center with respect to any bodily injury, illness, death, medical treatment that may arise from or in connection with my volunteer activities.

 

Confidentiality

I understand that while I am volunteering at the Damien Center, I may be given a volunteer assignment where I have access to Protected Health Information (PHI). PHI may include the client’s:

• Name
• Medical Record Number
• Date of Birth
• Pictures
• Social Security Number
• Address
• Email Address
• Telephone or Fax Number
• Diagnosis (HIV Status)
• Behavioral Plans
• Clinical Information
• Lab Reports

 

I understand that I am to keep in strictest confidence any information that I may gain during my volunteer assignments. I agree to refrain from any communications or action which could identify or cause harm to the clients about whom I may receive information during my assignment here at the Damien Center.

 

I understand that breach of this confidentiality, including the release of names of clients and information about individual clients without their consent, will result in the termination of my volunteer status and may result in subsequent civil and/or criminal penalties. 

 

COVID-19

I attest to the following statements:

• I am not experiencing any symptoms of illness such as fever, nausea, loss of taste, cough, or shortness of breath. I agree that I will cancel my shift to volunteer at Damien Center if any of these symptoms develop. 
• I do not believe that I have been exposed to a person with a confirmed or suspected case of COVID-19.
• I have not been diagnosed with COVID-19 and not yet cleared as noncontagious by state or local public health authorities.
• I am following recommended guidelines as much as possible - practicing social distancing by trying to maintain separation of six feet from others, always wearing a mask in public, and otherwise limiting my exposure to COVID-19.
• I understand I must follow the safety, hygiene, and social distancing protocols set forth by Damien Center and the city of Indianapolis
  

Volunteer Handbook

I am agreeing with the policies and guidelines for the volunteer program within Damien Center as described in the Volunteer Handbook. If I have any questions or concerns with the policies, I agree to speak with the Volunteer Manager in a timely manner.