In connection with my voluntary involvement in activities undertaken for and with the participation and support of Warren Village, Inc., a non-profit charitable organization, I hereby agree for myself, my heirs, assigns, executors and administrators to release and discharge Warren Village, Inc., its officers and directors, employees, agents, and volunteers harmless from any cause or action, claim or suit arising therefrom. I hereby attest that my involvement in such activities is voluntary, that I am participating at my own risk, and that I have read the terms and conditions of this release.
I understand and will adhere to appropriate behavior relating to issues of confidentiality, professionalism, non- discrimination and appropriate boundaries in dealing with clients, staff and other volunteers. I will adhere to safe work practices and procedures. I will refrain from use of all illegal drugs and abuse of all legal drugs while performing my duties as a Volunteer. I waive my right to privacy in the information, which I voluntarily provided, and agree to the use of my photograph and the photographs of my children for the publicity and public relations purposes of Warren Village, Inc.
I authorize Warren Village to investigate my background, including, but not limited to any criminal charges, proceedings, or convictions, personal references, whether obtained from national, state, or local databases or authorities.
I agree to hold harmless and to waive any and all claims I may have against Warren Village and its agents, employees, or other volunteers for any and all loss or injury I may sustain as a result of them investigating my background in accordance with this release. I also agree to hold harmless and to waive any and all claims I may have against any person who provides information to Warren Village in connection with the investigation of my background, for any and all loss or injury I may sustain as a result of any disclosure made in accordance with this release. I understand that this includes the possible rejection of my application as a volunteer.
I hereby confirm, represent and warrant that I have never been convicted with a felony*, violent crime, child abuse or neglect, child pornography, child abduction, kidnapping, rape or any sexual offense, nor have I been ordered by a court to receive psychiatric or psychological treatment in connection therewith.
All of the information that I provide during the course of the application process is complete and accurate to the best of my knowledge. I understand that misrepresentations or omissions are grounds for rejection of the application or dismissal as a volunteer.
DO NOT ACKNOWLEDGE UNTIL YOU HAVE READ THE ABOVE STATEMENT