Get Involved - Jivana Health Foundation

Volunteer Interest Form

Please note that submitting this form does not guarantee a volunteer placement. Once a suitable opportunity becomes available, a representative from Jivana Health Foundation will contact you.

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Student Name

First

Last

Student Phone Number

Parent/Gaudian Name

First

Last

Parent/Guardian Phone Number

Contact Email

High School Grade

How many total hours are you available to volunteer?

Health Initiatives/Nonprofit Volunteer (Health-focused 501(c)(3))

Retirement Home Visits
Blood Drive Volunteer
Health Education Campaigns
Fundraising Events for Medical Causes
Meal Preparation and Delivery to Seniors
Wellness & Mindfulness Workshop Organizer

High Name 501(c)(3))

Please specify your availability, including days and hours.

Please list the date, activity, and total number of hours. Each new record goes on a new line.

Terms and Agreement

I have read, understood, and voluntarily agree to the terms of this Volunteer Agreement, Waiver, and Release of Liability.

Volunteer Agreement, Waiver, and Release of Liability
By submitting this form and participating in any volunteer activities organized by Jivana Health Foundation (the “Organization”), I, the undersigned volunteer (or parent/guardian if under 18), hereby acknowledge and agree to the following terms:

Voluntary Participation:
I acknowledge that I am volunteering solely of my own accord and without any expectation of compensation, benefits, or future employment. My participation is not subject to any coercion or undue influence.

Assumption of Risk:
I understand and acknowledge that volunteering may involve certain risks, including but not limited to physical or emotional injury, illness, exposure to contagious diseases, or property damage. I knowingly and freely assume all such risks, both known and unknown, and accept full personal responsibility for participation.

Release of Liability:
I, on behalf of myself, my heirs, executors, assigns, and personal representatives, hereby release, discharge, and hold harmless Jivana Health Foundation, its officers, directors, agents, employees, partners, affiliates, and successors from any and all claims, demands, losses, liabilities, costs, or expenses arising out of or related to my participation in any volunteer activity.

Medical Treatment:
In the event of injury or medical emergency, I authorize the Organization to seek and obtain emergency medical treatment for me. I release the Organization from any liability or claim arising from any such treatment.

Confidentiality:
I agree to maintain the confidentiality of any proprietary, sensitive, or personal information to which I may have access during the course of my volunteering, including but not limited to health information, personal details, or internal organizational data.

Compliance with Policies:
I agree to abide by all policies, rules, and safety protocols set forth by the Organization and its partners. I understand that failure to comply may result in termination of my volunteer status.

Parental Consent (if under 18):
I, the parent/legal guardian of the minor volunteer named below, have read and fully understand the terms of this waiver and release, and I consent to the volunteer’s participation under these terms.

Parent/Guardian Signature (if under 18)

I have read, understood, and voluntarily agree to the terms of this Volunteer Agreement, Waiver, and Release of Liability.