Creating Healthy Communities

JCS Access, Information & Referrals: 305.576.6550

Hearing Impaired: 786.709.9431

• JCS Access, Information & Referrals: 305.576.6550
• Hearing Impaired: 786.709.9431
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• Forms and Waivers

Forms and Waivers

Contact Information and Consent Forms

Salutation

-------- Mr. Ms. Mrs. Dr. Prof. Rabbi

Name

Street

City

State/Province

Zip

Phone

Email

Date of Birth

Date of Birth

What is your preferred method of contact?

-------- Email Phone

How did you hear about JCS?

-------- Event Online Search Social Media Word of Mouth Other

What program are you interested in volunteering with?

-------- 211 Contact Center Cadena & JCS Crisis Center JCS Alliance JCS Latino Kosher Food Bank Meal Site Yehi Ohr

Are you volunteering for credit?

-------- Yes No

List your previous volunteer experience

Please check the days that you are available to volunteer

• Monday
• Tuesday
• Wednesday
• Thursday
• Friday

Please check the times that you are available to volunteer

• Morning
• Afternoon
• Evening

I certify that the above statements are true and correct to the best of my knowledge.

Volunteer Signature Please type your First and Last Name

Signature Date

Signature Date

JEWISH COMMUNITY SERVICES OF SOUTH FLORIDA, INC. VOLUNTEER ACTIVITIES RELEASE AND WAIVER OF LIABILITY

This Release and Waiver of Liability (the "Release") is executed by the undersigned, in favor of Jewish Community Services of South Florida, Inc., a Florida not-for-profit corporation, its affiliated organizations, directors, officers, employees, and agents ("JCS").
The undersigned desires to provide non-compensable volunteer services to JCS and its affiliated programs (the “Volunteer Services”). The Volunteer Services that the undersigned will engage include use of equipment, machinery and materials that if operated or used improperly or without appropriate judgement or proper training and experience could lead to serious personal injury, property damage and possible death, among other risks known or not readily foreseeable, to the undersigned or the others engaged in the Volunteer Services. The undersigned acknowledges that the Volunteer Services will be conducted on premises owned or operated by JCS and JCS does not want the benefit arising from the provision of the Volunteer Services by the undersigned unless the undersigned agrees to the following waiver and release.
In consideration of the moral and spiritual benefits arising from the Volunteer Services and other good and valuable consideration the receipt and sufficient of which the undersigned acknowledges, the undersigned hereby freely and voluntarily and knowingly, agrees to the following terms:
1. General Waiver and Release. The undersigned hereby releases and forever discharges sand hold harmless JCS, its affiliated organizations, directors, officers, employees, and agents, and its successors and assigns, from any and all liability, claims and demands of whatever kind of nature, either in law or in equity, which arise or may hereafter arise from my undertaking any Volunteer Services, whether such liability, claims, or demands result from my own action or those of others, unless those liabilities directly attributable to the gross negligence or the willful misconduct of JCS.
I understand and acknowledge that absent of proof of legal responsibility to the contrary this Release discharges JCS from any liability or claim that I may have against JCS with respect to any bodily injury, personal injury, illness, death, monetary loss or property damage that may result from my involvement in the Volunteer Services. I understand that JCS assumes no responsibility for or obligation to provide financial assistance or other assistance, including but not limited to medical, health, or disability insurance, in the event of injury, illness, death, monetary loss or property damage.
2. Accompanying Dependents/Companions. I understand that JCS assumes no responsibility of any sort for any injuries suffered, or costs/damages incurred by any of my dependents/companions accompanying me during the Volunteer Activities. I affirm that I have informed my accompanying dependents/companions of the fact that JCS assumes no responsibility for them if they choose to accompany me on my assignment.
3. Medical Treatment. I hereby release and forever discharge JCS from any claim whatsoever which arises or may hereafter arise on account of any first-aid treatment or other medical services rendered to me or to my dependents/companions in connection with an emergency if health problem during my engagement in the Volunteer Activities.
4. Assumption of Risk. I understand that the performance of the Volunteer Activities may include activities and circumstances that may be hazardous to me, including, but not limited to the use of equipment, machinery and materials that if operated or used improperly or without appropriate judgement or proper training and experience could lead to serious personal injury, property damage and possible death, among other risks known or not readily foreseeable. I hereby express and specifically assume the risk of injury or harm in the performance of the Volunteer Activities and release JCS from all liability for injury, illness, death, monetary loss or property damage resulting from such circumstances whether suffered by me personally or by any of my accompanying dependents or companions.
5. Personal And Professional Integrity. I understand that by participating in the Volunteer Activities of JCS, I must adhere to the code of ethics and business conduct. Therefore, I commit to perform the Volunteer Activities with integrity, and strive to meet the highest standards of performance, quality, service and achievement in working towards the JCS mission; to communicate honestly and openly to avoid misrepresentation; to exhibit respect and fairness toward all those with whom I come into contact; and agree to serve in adherence to the bylaws of JCS.
6. Non-Discrimination and Harassment Policy. In accordance to JCS’s committed to maintaining an environment free of harassment and discrimination on the basis of race, color, religion, gender, sex, national origin, age, marital status, sexual orientation or disability, I shall not tolerate harassment or discrimination of employees or volunteers by employees, volunteers, donors, vendors, suppliers or anyone else.
7. Political Contributions. As a charitable corporation, JCS is prohibited from making contributions to any candidate for public office or to any political committee. I therefore shall not make any contribution to any candidate for public office or political committee on behalf of JCS, including the use of JCS facilities, any branded materials/wearables or distribution lists for political campaign activities. Neither shall I make any contribution to or advocate for any candidate for public office or political committee in a manner that may create the appearance that the contribution is on behalf of JCS.
8. Confidentiality And Privacy. I understand that JCS has a legal and ethical responsibility to maintain the privacy and confidentiality of all subscriber information. I will not disclose any client information or discuss any such information with anyone except the Volunteer Director or an appropriate JCS staff member or other persons as determined by the CEO/President of JCS. I will not make unauthorized transmissions, copies, disclosures, inquiries, modifications or purging of client information.
9. Media Consent. I consent to release for possible publication my name, biographical information and/or any form of media, including but not limited to photographs, images, video or audio recordings of me or my likeness made by JCS in connection with providing volunteer services to JCS, for advertising, publicity, marketing and/or other commercial purposes. I understand that I will not be compensated for my voluntary participation or future use of any image or personal information used by Jewish Community Services of South Florida, Inc. (JCS), the Greater Miami Jewish Federation and other community partners.
10. Other. I expressly agree that this Release is intended to be as broad and inclusive as permitted by the laws of the State of Florida, and that this Release shall be governed by and interpreted in accordance with the laws of the State of Florida.
I HAVE READ THIS INSTRUMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT AND HAVE SIGNED IT FREELY AND WITHOUT INDUCEMENT OR ASSURANCE OF ANY NATURE AND INTEND IT TO BE A COMPLETRE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTEND ALLOWED BY LAW AND AGREE THAT IF ANY POSRTION OF THIS AGREEMENT IF HELP TO BE INVALID THE BALANCE, NOTWITHSTANDING, SHALL CONTINUE IN FULL FORCE AND EFFECT.
(All persons under the age of 18 participating in the Volunteer Activities must obtain the signature of a parent, legal guardian, or other responsible adult).

I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to Jewish Community Services' volunteer agreement and the release and waiver of liability above.