The Volunteer desires to work as a volunteer for AMEN and engage in the activities
related to being a volunteer for a Free medical and dental clinic (the
“Activities”). The Volunteer understands that the Activities may include
physical labor, exposure to bio-hazardous material such as blood and saliva, exposure
to dental cleaning chemicals, exposure to sharp instruments and tools, and/or other
circumstances that may result in personal injuries.
The Volunteer hereby freely, voluntarily, and without duress executes this Release
under the following terms:
1. Release and Waiver
Volunteer does hereby release and forever discharge and hold harmless AMEN and its
successors and assigns from any and all liability, claims, demands and whatever kind
or nature, either in law or in equity, that arise or may hereafter arise from
Volunteer’s Activities with AMEN. Volunteer understands that this release
discharges AMEN from any liability or claim that the volunteer may have against AMEN
with respect to any bodily injury, personal injury, illness, death, or property damage
that may result from volunteer’s activities with AMEN, whether caused by the
negligence of AMEN or its officers, directors, employees, or agents or otherwise.
Volunteer also understands that AMEN does not assume any 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 or illness.
2. Medical Treatment
Volunteer does hereby release and forever discharge AMEN from any claim whatsoever
which arises or may hereafter arise on account of any first aid, treatment, or service
rendered in connection with the Volunteer’s Activities with AMEN.
3. Assumption of the Risk
The Volunteer understands that the Activities may involve work that may be hazardous to
the Volunteer, including, but not limited to, cleaning, lifting, exposure to chemicals,
exposure to bio-hazardous waste, and risks from transportation to and from the clinic.
Volunteer hereby expressly and specifically assumes the risk of injury or harm in the
Activities, and releases AMEN from all liability for injury, illness, death, or
property damage resulting from the Activities.
4. Insurance
AMEN holds an insurance policy for our clinics also including things like med exp (any
one person) Personal & ADV injury. If desired, providers are encouraged and welcome
to take out an additional personal policy.
5. Photographic Release
Volunteer does hereby grant and convey unto AMEN all right, title, and interest in any
and all photographic images and video or audio recordings made by AMEN during the
Volunteer’s Activities with AMEN, including, but not limited to, any royalties,
proceeds, or other benefits derived from such photographs or recordings.
6. Other
Volunteer expressly agrees that this Release is intended to be as broad and inclusive as
permitted by the laws of the State of Tennessee and the state the clinic is operating
in. Volunteer also agrees that in the event that any clause or provision of this Release
shall be held to be invalid by any court of competent jurisdiction, the invalidity of
such clause or provision shall not otherwise affect the remaining provisions of this
Release which shall continue to be enforceable.
I, the volunteer, have executed the release as of the day and year written below. I
understand that this constitutes a legal signature confirming that I acknowledge and
agree to the above terms of acceptance.
