Name *

First Name

Last Name

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

I am over 18 years old *

Yes

No

Have you been arrested, convicted, or charged with a misdemeanor or felony or any crime in the entire United States, in your lifetime? *

Yes

No

Have you ever been in drug or alcohol rehabilitation for any reason? *

Yes

No

Do you consent to a background screening or check, if HT determines it is necessary for this position? *

Yes

No

What is your current knowledge of human trafficking? *

Advanced

Intermediate

Some Knowledge

Beginner

What committee are you interested in joining? Check all that apply. *

Education

Fundraising

Outreach

Community Engagement

Special Events

This Release and Waiver of Liability releases The Human Trafficking Coalition of the Palm Beaches, Inc., a designated 501(c)(3) public charity under Section 501(c)(3) of the Internal Revenue Code (Tax ID# 84-2523173), organized and existing under the laws of the State of Florida. The Volunteer desires to provide volunteer services for The Human Trafficking Coalition of the Palm Beaches, Inc. and engage in activities related to serving as a volunteer. The Volunteer understands that the scope of Volunteer’s relationship with The Human Trafficking Coalition of the Palm Beaches, Inc. is limited to a volunteer position and that no compensation is expected in return for services provided by the Volunteer; that The Human Trafficking Coalition of the Palm Beaches, Inc. will not provide any benefits traditionally associated with employment to the Volunteer; and that the Volunteer is responsible for his or her own insurance coverage in the event of personal injury or illness as a result of the Volunteer’s services to The Human Trafficking Coalition of the Palm Beaches, Inc. Waiver and Release: I, the Volunteer, releases and forever discharge and holds harmless The Human Trafficking Coalition of the Palm Beaches, Inc. 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 the services I provide to The Human Trafficking Coalition of the Palm Beaches, Inc. I understand and acknowledge that this Release discharges The Human Trafficking Coalition of the Palm Beaches, Inc. from any liability or claim that I may have against The Human Trafficking Coalition of the Palm Beaches, Inc. with respect to bodily injury, personal injury, illness, death, or property damage or any other claims of any type that may result from the services I provide to The Human Trafficking Coalition of the Palm Beaches, Inc. or occurring while I am providing volunteer services. Insurance: Further I understand that The Human Trafficking Coalition of the Palm Beaches, Inc. 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 The Human Trafficking Coalition of the Palm Beaches, Inc. beyond what may be offered freely by The Human Trafficking Coalition of the Palm Beaches, Inc. in the event of injury or medical expenses incurred by me. Medical Treatment: I hereby Release and forever discharge The Human Trafficking Coalition of the Palm Beaches, Inc. 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 The Human Trafficking Coalition of the Palm Beaches, Inc. Assumption of Risk: I understand that the services I provide to The Human Trafficking Coalition of the Palm Beaches, Inc. may include activities that may be hazardous to me. As a volunteer, I hereby expressly assume risk of injury or harm from these activities and Release The Human Trafficking Coalition of the Palm Beaches, Inc. from all liability. Photographic Release: I grant and convey to The Human Trafficking Coalition of the Palm Beaches, Inc. all right, title, and interests in any and all photographs, images, video, or audio recordings of me or my likeness or voice made by The Human Trafficking Coalition of the Palm Beaches, Inc. in connection with my providing volunteer services to The Human Trafficking Coalition of the Palm Beaches, Inc. 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 of Florida and that this Release shall be governed by and interpreted in accordance with the laws of the State of Florida. 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 electing to click 'AGREE', I express my understanding and intent to enter into this Release and Waiver of Liability willingly and voluntarily. *

I AGREE Release and Waiver of Liability

Volunteer also agrees to confidentiality of the identity of, and all conversations with, any human trafficking victim, beyond communication with the Human Trafficking Task Force members or employees, or other professionals, to the extent necessary to effectively volunteer, as volunteer understands the sensitive nature and needs of human trafficking victims. *

I AGREE to Confidentiality Agreement