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Middlesex Habitat for Humanity

Becoming a Volunteer


Thank you for your willingness to volunteer and help a family live in safe, affordable decent housing. The volunteer options at this time are: Westbrook Home Build at 382 Hammock Rd N. For our home build, no training is needed and you must stay the whole day. For Westbrook, the hours are 8:30 am to 3:30 pm, Wednesday, Friday, and Saturday. The Committees are Board of Directors, Building, Home Owner's Support, Special Events, and Resource Development. Our Committees meet once a month. To sign up for a committee, contact Maria Lopez at 860-398-6483 or mlopez@habitatmiddlesex.org. Another opportunity which is not available at this time due to Covid-19 is at our ReStore. At the ReStore you will perform any of the following; assist customers, load, unload, and move furniture and appliances, stock shelves, and cashier. The store is located at 34 Shunpike Rd in Cromwell. The hours are Wednesday to Saturday 10:00am to 4pm. Please check our website for updates.

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Your information


Required fields are marked with an asterisk (*)
First Name *
Last Name *
Birthdate *

A valid date as MM/DD/YYYY (for example: 11/30/2015)
Street Address *
Town *
State *
Zip *
Phone Number *

For example, 123-456-7890
Which number did you provide above? *
Email Address *
Emergency Contact Name *
Emergency Phone Number *
Employer/School/Organization
Are You Completing Community Service Hours? *
If yes, how many service hours do you have to complete?
Any Allergies or Restrictions

Waiver

Volunteer Agreement,
Release and Waiver of Liability
PLEASE READ CAREFULLY!
THIS IS A LEGAL DOCUMENT THAT AFFECTS YOUR LEGAL RIGHTS!
This Release and Waiver of Liability (the “Release”) is executed on this day of _____, 20___, by
_____________________________, (the “Volunteer”), in favor of _Middlesex Habitat for Humanity_______________________________
[insert name of local affiliate or national organization], Habitat for Humanity International, Inc. and any other
Habitat for Humanity affiliated organization1
, _________________________________________________
[insert any additional parties if applicable, such as sponsors/donors] and their respective affiliates, directors,
officers, trustees, employees, sponsors, donors, volunteers and agents (collectively, the “Released
Parties”).

I, the Volunteer, desire to work as a volunteer for one or more of the Released Parties without compensation
and engage in the activities related to being a volunteer. I understand that my activities may include but are
not limited to the following: working at Habitat for Humanity offices and worksites; working in or for Habitat
for Humanity ReStore operations; loading and unloading materials; traveling to and from work sites, towns,
cities or countries; consuming food available or provided; living in housing provided for volunteers; assisting
in disaster relief areas; constructing, repairing, and rehabilitating residential buildings; other construction related activities; and other volunteer activities ("Activities").

I, the Volunteer, understand that my Activities may include work that may be hazardous to me, including,
but not limited to, exposure to lead, asbestos and mold, which may cause or worsen certain illnesses,
especially if I do not wear protective equipment, am exposed for extended periods of time, or have a preexisting immune system deficiency.

I also understand there is some inherent risk in consuming local foods and living in local accommodations
in the city(ies) or country(ies) visited. I further understand I may be traveling to and from locations where
there is a risk of terrorism, war, insurrection, criminal activities, instability, inclement weather or other
circumstances that could threaten my health or safety. I also understand that it is the policy of the Released
Parties not to pay ransom or make any other payments to secure the release of hostages.

I, the Volunteer, hereby freely, voluntarily and without duress execute this Release under the following
terms:

Each Habitat for Humanity affiliate is an independently owned and operated non-profit corporation. Habitat for Humanity
International, Inc. does not own, operate, or control the activities of Habitat for Humanity affiliated organizations.

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Release and Waiver. I, the Volunteer, acknowledge and understand that participation in the Activities
may involve certain risks, including, but not limited to, personal injury(ies), bodily injury, illness, permanent
disability, property damage, loss and/or death (“Risks”). These Risks include, but are not limited to,
exposure to and/or infection with COVID-19 and/or other viruses and/or bacterial infection even in ideal
conditions, and despite any and all reasonable efforts made to mitigate such Risks. I further acknowledge
and agree that, due to the nature of the Activities, social distancing of six feet per person will not always
be possible and that my participation in the Activities may result in an elevated risk of contracting COVID-19 and/or other viruses and/or bacterial infection.

I, the Volunteer, further confirm that prior to engaging in the Activities, I may be required to complete a
COVID-19 health screening questionnaire provided by one or more of the Released Parties. I agree that I
will answer all questions on the questionnaire truthfully. I agree to not participate in any Activities if, at such
time and to the best of my knowledge, I am a carrier of COVID-19 or infected with COVID-19. I further
agree to follow all safety precautions outlined by any Released Party while volunteering. Since persons with a history of violent or sexual crimes will not be allowed to volunteer, I agree that a search will be conducted in the National Sex Offender Public Website.

In consideration of and in order to be allowed to participate in the Activities, I do hereby release and forever
discharge and hold harmless the Released Parties and their successors and assigns from any and all
liability, claims, demands, costs and damages of any kind, whether arising from tort, contract or otherwise,
which I or my heirs, assigns, next of kin or legal representatives may have or which may hereinafter accrue,
arise from, or are in any way related to my Activities with any of the Released Parties, including but not
limited to Risks, whether caused wholly or in part by the simple negligence, fault or other misconduct of
any of the Released Parties or of other volunteers, other than their intentional or grossly negligent conduct.
In addition, the Released Parties shall have the benefit of any future liability protection for businesses as
relating to the COVID-19 pandemic passed by any governmental entity to which the Released Parties are
subject.

I understand and acknowledge that by signing this Release I knowingly assume the Risks associated with
the Activities. I also understand that the Released Parties do 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, illness, death or property damage. Regarding any illness or virus, including
COVID-19, I, the Volunteer, understand that even if I follow all guidelines for the prevention and handling
of any illness or virus, including COVID-19, there is still a risk that Volunteer could contract such virus or
illness.

I understand and acknowledge that children under the age of 16 are not allowed on Habitat for Humanity
worksites while construction is in progress. While minors between the ages of 16 and 18 may be allowed
to participate in some types of build site activities, solely as outlined by the Released Parties, I understand
that using power tools, excavation, demolition, working on rooftops and similar activities are not permitted
for anyone under the age of 18. I agree it is my responsibility to communicate these requirements to any of
my minor children who will attend and/or participate in the Activities.

Consent to Transportation and Medical Treatment. I consent to the use of first aid treatment and the
use of generic and over-the-counter medications and treatments as directed by manufacturer labels,
whether administered by the Released Parties or first aid personnel. In an emergency, I understand the
Released Parties may try to contact the individual listed below as an emergency contact. If an
emergency contact cannot be reached promptly, I hereby authorize the Released Parties to act as an
agent for me to consent to any examination, testing, x-rays, medical, dental or surgical treatment for me
as advised by a physician, dentist or other health care provider. This includes, but is not limited to, my
assessment, evaluation, medical care and treatment, anesthesia, hospitalization, or other health care
treatment or procedure as advised by a physician, dentist or other health care provider. I also authorize

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the Released Parties to arrange for transportation of me as deemed necessary and appropriate in their
discretion. I, the Volunteer, do hereby release, forever discharge and hold harmless the Released
Parties from any liability, claim, demand, and action whatsoever brought by me or on my behalf which
arises or may hereafter arise on account of any transportation, first aid, assessment, care, treatment,
response or service rendered in connection with my Activities with any of the Released Parties.

If the Volunteer is less than 18 years of age, the parent(s) having legal custody and/or the legal guardian(s)
of the Volunteer also hereby release, forever discharge and hold harmless the Released Parties from any
liability, claim, demand and action whatsoever brought by such volunteer or on his/her behalf which arises
or may hereafter arise on account of the decision by any representative or agent of the Released Parties
to exercise the power to transport, administer first aid, and consent to assessment, examination, x-rays,
medical, dental, surgical or other such health care treatment as set forth in the Parental Authorization for
Treatment of, and Travel With, a Minor Child.

Insurance. I understand that, except as otherwise agreed to by the Released Parties in writing, the
Released Parties are under no obligation to provide, carry or maintain health, medical, travel, disability or
other insurance coverage for any Volunteer. Each Volunteer is expected and encouraged to obtain his or
her own health, medical, travel, disability or other insurance coverage.

I understand that I am and remain responsible for payment of such hospital, physician, ambulance, dental,
medical or other services obtained for me or my child. I agree that the Released Parties do not assume any
responsibility for the payment of such fees or expenses which may be incurred. If I have health insurance,
I understand my personal health insurance is my primary coverage.

Confidentiality. I agree that in the course of my participation in the Activities, I may have access to personal
and/or health care information of other persons. I agree to maintain the confidentiality of such information,
to use such information only as necessary to do my job as a volunteer, and to comply with Habitat for
applicable policies regarding such information.

Photographic/Recording Release. I hereby grant and convey unto the Released Parties all right, title and
interest in any and all photographs and video/audio/electronic recordings of me, including as to my name,
image and voice, made by or on behalf of any of the Released Parties during my Activities with the Released
Parties, including, but not limited to, the right to use such materials for any purpose and to any royalties,
proceeds or other benefits derived from them. I understand that I will not have any ownership interest in or
to such photographs, images and/or recordings, I have not been provided or promised any compensation
to me, and I hereby waive any rights, privileges or claims based on any right of publicity, privacy, ownership
or any other rights arising, relating to or resulting from the photographs, images and/or recordings. I
understand and agree that this paragraph also applies to my minor child(ren) who are volunteering.

Other. I expressly agree that this Release is intended to be as broad and inclusive as permitted by state
law. I further agree that in the event any clause or provision of this Release is held invalid by any court of
competent jurisdiction, the invalidity of such clause or provision shall not otherwise affect the remaining
clauses or provisions of this Release, which shall continue to be enforceable. Further, a waiver of a right
under this Release by a Released Party does not prevent the exercise of any other right.

I have carefully considered my decision, the benefits and risks involved, and hereby give my informed
consent to participate in all volunteer Activities. I have read and understand this Release and Waiver of
Liability, I acknowledge that any questions of mine have been answered, and I voluntarily agree to the
above provisions. It is my intent to bind my heirs, next of kin, assigns and legal representative.

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SIGNATURE OF VOLUNTEER 18 YEARS OR OLDER:

Volunteer: Name (please print):________________________Signature:_________________________

Address:____________________________________________________________________________

Phone: (H)______________ (C)_______________ Email:_____________________________________

Date of Birth:_________________________________________________________________________

Witness: Name (please print):_________________________ Signature: _________________________

EMERGENCY CONTACT INFORMATION FOR VOLUNTEER OVER 18 YEARS OF AGE:

Name :_________________________________ Relationship: ______________________________

Address: _________________________________________________________________________

Phone: (H) ____________________ (C) _____________________ (W) _____________________

Email: _______________________________________________________________________


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REVISION HISTORY

Date Explanation

July 2020 The volunteer waiver template was reviewed in July 2020 as part of a regularly
scheduled legal review process. While the previous waiver template contained broad
assumption of risk language, additional language was added to expressly address
COVID-19 related risks. This includes requiring that all volunteers agree to comply
with all COVID-19 protocols set by Habitat, as well as specific and increased release
language for COVID-19 related damages. In addition to COVID-19 updates, the July
2020 version of the volunteer waiver template makes minor adjustments to the youth
activities and photo release sections. Lastly, it addresses situations where only one
parent or legal guardian is signing on behalf of a minor. Affiliates should continue to
consult with their Boards and local counsel for state-specific issues related to volunteer
waivers.