Volunteer – Integrative Providers Association

Volunteer Release and Waiver of Liability Form

Please Fill Out The Form Below

Name(Required)

First Last

Email(Required)

Profession(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Upload Headshot (300x300 pixels)(Required)

Max. file size: 12 GB.

This Release and Waiver of Liability (the “release”) executed on today's date as timestamped where indicated below my acceptance of these terms. As such, I agree as follows:

(“Volunteer”) releases Integrative Providers Association (“IPA”) and Compassion Center, a pair of nonprofit organizations and each of their directors, officers, employees, and agents respectively.

The Volunteer desires to provide volunteer services for IPA and/or Compassion Center during an event and/or conference and engage in activities related to serving as a volunteer.

Volunteer understands that the scope of Volunteer’s relationship with IPA and Compassion Center is limited to a volunteer position and that no compensation is expected in return for the services provided by the Volunteer; that IPA and Compassion Center will not provide any benefits traditionally associated with employment to Volunteer; and that Volunteer is responsible for his/her own insurance coverage in the event of personal injury or illness as a result of Volunteer’s services to IPA.

1. Waiver and Release: I, the Volunteer, release and forever discharge and hold harmless the IPA and Compassion Center and both organizations' 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 the services I provide to IPA or Compassion Center.

I understand and acknowledge that this Release discharges IPA and Compassion Center from any liability or claim that I, or my heirs may have against IPA and/or Compassion Center with respect to bodily injury, personal injury, illness, death, or property damage that may result from the services I provide to IPA or Compassion Center, or occurring while I am providing volunteer services to either.

2. Insurance: Further I understand that IPA and Compassion Center does not assume any responsibility for or obligation to provide me with financial or other assistance, including but not limited to medical, health, or disability benefits or insurance.

I expressly waive any such claim for compensation or liability on the part of IPA and/or Compassion Center beyond what may be offered freely by IPA or Compassion Center in the event of injury or medical expenses incurred by me.

3. Medical Treatment: I hereby Release and forever discharge IPA and Compassion Center from any claim whatsoever which arises or may hereafter arise on account of any first-aid treatment or other medical services rendered in connection with an emergency during my tenure as a volunteer with IPA or the Compassion Center.

4. Assumption of Risk: I understand that the services I provide to IPA and Compassion Center may include activities that may be hazardous to me including, but not limited to: sitting/standing, lifting, carrying, set-up/break-down, driving, traveling and/or involving inherently dangerous activities.

As a volunteer, I hereby expressly assume risk of injury or harm from these activities and Release IPA and Compassion Center from any/all liability.

>5. Photographic Release: I grant and convey to IPA and Compassion Center all right, title, and interests in any and all photographs, images, video, or audio recordings of me or my likeness or voice made by IPA and Compassion Center in connection with my providing volunteer services to IPA and Compassion Center without compensation, in films and tapes for exploitation in any and all media, whether now known or hereafter devised, for eternity.

6. Code of Conduct: I have received and understand the IPA Code of Conduct and will act in accordance with the bylaws.

7. Professionalism: I agree to dress professionally, wear my volunteer name badge, arrive on time, and perform my agreed upon duties in a timely and professional manner. If I have any questions or am unable to make it to my assigned duty I will immediately call the main lead and notify them. I understand I will be representing IPA and Compassion Center and will not discuss any personal business or promote any brands, events, organizations with the attendees, speakers, or guests during IPA conferences and related events.

8. I will promote IPAs Mission:

IPA Mission: Integrative Providers Association is a nonprofit 501(c) organization dedicated to advancing the societal benefits of Integrative Medicine in the established healthcare, legislative and socioeconomic systems that currently serve the greater population of public health globally focusing on Discovering- Educating- Uniting- Empowering providers together while providing Integrative Wholeness and Inclusion for the betterment of tomorrow.

I AM the IPA

I understand and will support this mission as I interact with IPA conference and event attendees and their sponsors.

I understand that they are licensed medical professionals and will provide them with the utmost dignity and respect.

9. For Educational Purposes Only. I understand and acknowledge that IPA hosts public events and I will abide by state laws and hold IPA and Compassion Center harmless of any action I perform against this agreement. If I break these rules, I understand I may be excused and discharged from my duties and will be asked to remove myself from the premises immediately.10. Other: As a volunteer, I expressly agree that this Release is intended to be as broad and inclusive as permitted by the laws of the State in which I work and that this Release shall be governed by and interpreted in accordance with the laws of such state. I agree that in the event that any clause or provision of this Release is deemed invalid, the enforceability of the remaining provisions of this Release shall not be affected.

By entering my information and clicking the Check Box below stating that I agree, I express my understanding and intent to enter into this Release and Waiver of Liability willingly and voluntarily.

I Agree to The Above Terms and Conditions(Required)

I Understand and Agree To The Above Terms and Conditions.

CAPTCHA