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First Name *
Last Name *
Pronouns *
Mobile Phone *

For example, 123-456-7890
Besides English, what languages below are you conversational in? (check all that apply)









Do you have access to a car? *
SELAH Service Areas You Live or Work In (check all that apply):





Do you have any professional experience working with the unhoused community? (If not, that’s ok!) *
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Do you have any special skills you are willing to donate?

Waiver

SELAH Volunteer Release and Waiver of Liability Form

This Release and Waiver of Liability (the “Release”) executed on [Date of Signature]
by [Your Name] (“Volunteer”) releases SELAH Neighborhood Homeless
Coalition (“SELAH”), a nonprofit corporation organized and existing under the laws of the State of California and each
of its directors, officers, employees, and agents. The Volunteer desires to provide volunteer services for SELAH
Neighborhood Homeless Coalition and engage in activities related to serving as a volunteer.
Volunteer understands that the scope of Volunteer’s relationship with SELAH is limited to a volunteer position and
that no compensation is expected in return for services provided by Volunteer; that SELAH 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 for SELAH.

1. Waiver and Release: In consideration of Volunteer’s desire to provide volunteer services for SELAH,
Volunteer and Volunteer’s heirs, executors, guardians, administrators, successors, and assigns (the
“Releasing Parties”), releases and forever discharges and holds harmless SELAH, each of its successors
and assigns, and each of SELAH’s directors, officers, employees, agents, and each of their successors and
assigns (the “Released Parties”) from any and all liability, claims, and demands of whatever kind of nature,
either in law or in equity, which arise from or are related to the services Volunteer provides to SELAH.
Volunteer understands and acknowledges that this Release discharges the Released Parties from any
liability or claim that Volunteer and the Releasing Parties may have against the Released Parties, including
without limitation, claims arising from bodily injury, illness, death, or property damage that may result from or
are related to the services Volunteer provides for SELAH.

2. Insurance: Further Volunteer understands that SELAH 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. Volunteer expressly waives any such claim for compensation or liability on the part of
SELAH in the event of injury or medical expenses incurred by Volunteer.

3. Medical Treatment: Volunteer and the Releasing Parties hereby releases and forever discharges the
Released Parties from any claim whatsoever which arises or may hereafter arise on account of any first-aid
treatment or other medical services rendered during or in connection with the provision of volunteer services
for SELAH.

4. Assumption of Risk: Volunteer understands that the services Volunteer provides for SELAH may include
activities that may be hazardous to Volunteer. Volunteer hereby expressly acknowledges and assumes all
risk of bodily injury, property damage, or any other harm that Volunteer may sustain while providing such
services.

5. Photographic Release: Volunteer grants and conveys to SELAH all right, title, and interests in any and all
photographs, images, video, or audio recordings of Volunteer or Volunteer’s likeness or voice made by
SELAH in connection with the provision of volunteer services to SELAH.

6. Other: Volunteer expressly agrees that this Release is intended to be as broad and inclusive as permitted
by the laws of the State of California and that this Release shall be governed by and interpreted in
accordance with the laws of the State of California. Volunteer further agrees 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 signing below, Volunteers acknowledges that Volunteer has carefully read the foregoing and understands the
content thereof and expresses Volunteer’s intent to enter into this Release willingly and voluntarily.