Choose a place you would like to Volunteer at
Nemours / AI duPont Hospital for Children
CHOP: Children’s Hospital of Philadelphia
Shriners Hospital for Children
St. Christopher’s Hospital for Children
Ronald McDonald House
Wesley House Shelter
Philadelphia Children’s Alliance
Bryn Mawr Hospital
Parent/Legal Guardian if under 18 years of age (Must be at least 16 years old)
Please check any of the Skills and Interests you may have.
Forms of Art
Forms of Music
What areas can you assist in that will work best for you?
Please Provide a Brief Background About yourself
General Volunteer Waiver of Liability in favor of Little Smiles, Inc., a non-profit organization, its directors, officers, employees, agents, and representatives, and their respective successors and assigns, heirs, executors, and administrators (collectively “LITTLE SMILES, INC.”). The Volunteer desires to work as a volunteer for Little Smiles, Inc. and engage in the activities related to being a volunteer (the “Activities”). The Volunteer understands that the Activities may include, but are not limited to, providing transportation (using their own vehicle), cooking, carrying and lifting items, participating in special events and fundraisers, and engaging in other activities relevant to Little Smiles, Inc. The Volunteer hereby freely, voluntarily and without duress executes this Release under the following terms: Release and Waiver: Volunteer does hereby release and forever discharge and hold harmless LITTLE SMILES, INC. and its successors and assigns from any and all liability, claims and demands of whatever kind or nature, wither in law or in equity, which arise or may hereafter arise from Volunteer’s Activities with LITTLE SMILES, INC. Volunteer understands that this Release discharges LITTLE SMILES, INC. from any liability or claim that the Volunteer may have against LITTLE SMILES, INC. with respect to any bodily injury, personal injury, illness, death, or property damage that may result from the Volunteer’s Activities with LITTLE SMILES, INC., whether causes by the negligence of LITTLE SMILES, INC. or its offices, directors, employees or otherwise. Volunteer also understands that LITTLE SMILES, INC 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. Medical Treatment: Volunteer does hereby release and forever discharge LITTLE SMILES, INC. 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 LITTLE SMILES, INC. Assumption of Risk: The Volunteer understands that the Activities include work that may be hazardous to the Volunteer, including, but not limited to, transportation. Volunteer hereby expressly and specifically assumes the risk of injury or harm in the Activities and release LITTLE SMILES, INC. from all liability for injury, illness, death, or property damage resulting from the Activities. Insurance: The Volunteer understands that LITTLE SMILES, INC. does not carry or maintain health, medical, or disability insurance for any Volunteer. Photographic Release: Volunteer does hereby grant and convey unto LITTLE SMILES, INC. all rights, title and interest in any and all photographic images and video or audio recordings made by LITTLE SMILES, INC. during the Volunteer’s Activities with LITTLE SMILES, INC., including, but not limited to, any royalties, proceeds, or other benefits derived from such photographs or recordings. Other: Volunteer expressly agrees 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. Volunteer agrees that in the event that any clause or provision of this Release shall be held to be invalid by any court of competent jurisdictions, the invalidity of such clause or provision shall not otherwise affect the remaining provisions of this Release which shall continue to be enforceable. Recognizing that Little Smiles serves a diverse multi-cultural and multi-generational clientele going through a various number of hardships, I realize that the often well-meaning actions of volunteers can have unintended consequences. Therefore, in order to protect the image and credibility of Little Smiles, I fully acknowledge that… …Little Smiles is not responsible for damage to volunteer’s personal property. This includes, but it not limited to, hand bags, purses, eye glasses, and automobiles used at Little Smiles serviced facilities. …a volunteer at Little Smiles serves at the pleasure of Little Smiles staff. A volunteer’s service may be terminated at any time. …a volunteer is encouraged to bring any concerns about policy and/or procedure to the immediate attention of the Executive Director. …a volunteer at Little Smiles is not permitted under any circumstance to be alone with a client off site. Violation of this rule will result in immediate termination of volunteer service. …a volunteer at Little Smiles is not permitted under any circumstance to drive a client to any destination in his/her personal vehicle. Violation of this rule will result in immediate termination of volunteer service. …a volunteer at Little Smiles is not permitted under any circumstance to visit a client in their home, apartment or residence. Violation of this rule will result in immediate termination of volunteer service. …a volunteer may not, under any circumstance, give personal funds, money or goods to a client. Violation of this rule will result in immediate termination of volunteer service. …a volunteer may not, under any circumstance make lewd or offensive jokes or comments referring to a client’s age, race, ethnicity, color, creed, religious beliefs or sexual orientation. Violation of this rule will result in immediate termination of volunteer service. …a volunteer under the age of 18 may not travel with a representative of Little Smiles off site without the written consent of a parent or guardian.
I acknowledge and accept waiver