Volunteer Agreement |

Thank you for your interest in volunteering for There With Care of the Bay Area. We value your privacy and respect your honesty. Volunteer applications are kept confidential, using the same standard of privacy as dictated by HIPAA.

Please read through the following agreement, check your acceptance, sign below and submit. We thank you for your time.

Contact Information

Name*

First Last

Email*

Release Acknowledgements

Photographic and/or Video Release: I hereby give my permission to be photographed and/or videotaped, and I understand that the resulting photographs may appear on the website and other marketing materials for There With Care. For valuable consideration, receipt and sufficiency of which is hereby acknowledged, but without a fee, I hereby irrevocably grant There With Care and its licensees and assigns the right to use all or any part of the photographs and/or video. I agree that I shall have no right, title, or interest in or to the photographs or any version thereof, including without limitation claims based upon right of privacy or right of publicity, or for any fees or other considerations for such use. This release shall be construed according to the laws of the State of Colorado, without regard to its choice of law provisions.*

Yes
No

Please check yes or no to give or refuse permission for photography and video use.

Confidentiality, Conflict of Interest, and Ethics Statement: As a volunteer of There With Care, I have an obligation to the organization I serve, to the general public, and to myself to maintain the highest standards of ethical conduct. I will not commit acts contrary to these standards nor will I condone the commission of such acts by others within the organization. I have a responsibility to: Confidentiality Keep confidential information confidential unless legally obligated to do otherwise. Refrain from using or appearing to use confidential information acquired in the course of my service for unethical or illegal advantage either personally or through third parties. Conflict Of Interest Avoid direct or indirect, actual or apparent, conflicts of interest and advise all appropriate parties of any potential conflict, if: • A There With Care representative's personal business provides goods or services to There With Care for consideration. • A friend or relative of There With Care representative provides goods or services to There With Care for consideration. • A vendor or business acquaintance with whom a There With Care representative has an outside business relationship provides goods or services to There With Care for consideration. Ethics Statement Refrain from engaging in any activity that would prejudice my ability or the ability of others to carry out duties ethically. Refuse any gift, favor, or hospitality that would influence or would appear to influence my actions or the actions of others, for example: • A There With Care representative receives a referral fee or preferential discount, gift, or other valuable consideration from a vendor, paid promoter, fund-raising event sponsor, or any other outside party, for referring There With Care business to such party.*

Yes

Please check to confirm that you have read and understand the statements above.

Release of Liability: Participants hereby release and agree to indemnify and hold There With Care harmless for, from and against any and all liability, damages and claims (“claims”) of any kind, known and unknown, which may be connected with, result from, or arise out of care or services provided by There With Care including, but not limited to, claims involving economic loss, illness or medical condition, accidental injury or death, suffered by any of the participants. Such services include without limitation the delivery of food, clothing, transportation, professional services, therapeutic support, home maintenance, and other product services. Participants hereby acknowledge that they understand such services and products may entail risk of injury or harm to the participants and agree that this risk is fully assumed by the participants. Participants agree that this Liability Release fully and accurately expresses their understanding and has not been and shall not be modified except in writing signed by each of the Participants and There With Care.*

Yes

Please check to confirm that you have read and understand the statements above.

Date*

Signature

Thank You and Next Steps

We thank you for your interest in volunteering for There With Care of the Bay Area, supporting our mission to care for families facing critical illness. Please note, in order to protect the privacy of the families we serve and to comply with our HIPAA obligations, anyone 18 years of age or older volunteering in a capacity that involves family contact or access to family information is required to complete a criminal background check that will be automatically renewed every three years while the volunteer is actively volunteering. Once you submit this application and register for a Volunteer Training, a confirmation email will be sent containing a link to submit your background check.