COMMON GROUND COLLECTIVE

Warning, Waiver, Assumption of Risk and Release of Liability

Here at Common Ground Collective, we come together, each of our own volition, to be of help to residents of New Orleans and surrounding areas, who have suffered losses as a result of hurricanes Katrina and Rita andthe flooding and contamination that followed.

As individuals coming together, each of our own volition, volunteering our help, we come to help with the understanding that the Common Ground Collective (CGC) operates on a shoestring budget, and CGC cannot be and is not responsible for injuries or loss of life, that might occur to any volunteer who joins CGC to help.

Every person who comes to help at CGC, is strongly encouraged to have their own insurance, to cover costs they might incur as a result of injuries sustained while working here with CGC. CGC does our utmost to provide certain protective gear for our volunteers (gloves, boots, dust masks), and clean water for drinking, hand-washing and bathing. All volunteers are STRONGLY ENCOURAGED to practice conscientious hand-washing, in order to mitigate the spread of germs which could cause illness.

CGC also provides food for its volunteers, free of charge. Volunteers should be able to prepare, wash or cook their own meals, from the foods CGC provides. Some meals are prepared in quantity, by CGC volunteers, to be shared equally with all of CGC’s volunteers. CGC uses bleach to clean dishes and food preparation surfaces, and at least one volunteer cleans up the communal kitchen area after each communal meal that is prepared. When volunteers prepare their own meals, they are expected to clean up thoroughly after themselves (spills of milk, juice, other liquids or food crumbs) and to wash any dishes or utensils they use. This helps keep down the presence of flies at our Collective, and helps keep germs from spreading.

Whether or not you have insurance, CGC requests that each volunteer sign this waiver below.

[ ] I, ________________________________________ (please PRINT your name), hereby waive, release and discharge any and all claims for damages for death, personal injury or property damage which I may have, or which hereafter accrue to me, against Common Ground Collective (Common Ground) as a result of my participation as a volunteer. This release is intended to discharge Common Ground, its trustees, officers, employees and volunteers, and any public agencies from and against any and all liability arising out of or connected in any way with my participation as a volunteer. I further understand that accidents and injuries can arise out of volunteering; knowing the risks, nevertheless, I hereby agree to assume those risks and to release and to hold harmless all of the persons or agencies mentioned above who might otherwise be liable to me (or my heirs or assigns) for any loss or damages. It is further understood and agreed that this waiver, release and assumption of risk is to be binding on my heirs and assigns. It is the intention of the parties hereto that the provision of this paragraph be interpreted to impose on each party responsibility for their own negligence.

I acknowledge that I have been fully informed of the risks and dangers involved with volunteering at Common Ground. I acknowledge that I have read, agree, and fully understand the above Warning, Waiver, Assumption of Risk and Release of Liability. I further acknowledge and agree that the reasons for my being requested to sign this Release have been fully explained to me and I understand them.

I am signing this Release of my own free will and I have not been influenced or coerced by any representative of Common Ground.

[ ] I, ________________________________________ (PRINT) am 18 years old or older and hereby give my permission for Common Ground to seek medical care for above mentioned volunteer, in the event s/he is injured and is not able to make my her/his decisions regarding medical care.

Volunteer signature ______________________________ Today’s Date __________________

Legal Name_________________________________________ Age_____ Date of Birth _____________

Volunteer Cell Phone (If any) _________________________

Address ____________________________________________ Phone_____________________________

Emergency Contact 1 _________________________________ Phone ____________________________

Emergency Contact 2 _________________________________ Phone ____________________________

Arrival Date __________________________ Departure Date __________________________________

Cell Phone______________________________________ Email___________________________________