I am applying for volunteer service for Hearts With A Mission (HWAM), whose primary purpose is to provide shelter, individual case management, and follow up care to homeless youth in Jackson County.
I certify that all statements made in my application and all descriptions of my work history are true, accurate and complete. I hereby expressly authorize Hearts With A Mission, its officers, agents and employees, to investigate in any manner they deem appropriate, at their sole discretion, my medical, health, educational, employment, community service or professional background, public or private records including but not limited to law enforcement and court records and personal references. I further consent to and authorize Hearts With A Mission to communicate with any and all of my previous or current employers relating to my work record and experience.
In consideration of being evaluated for volunteer service with Hearts With A Mission, I hereby release and forever discharge Hearts With A Mission, its officers, agents and employees from any and all claims, demands, damages or liability relating to or arising out of the requesting of, or furnishing of, any information relating to my medical, health, educational, employment, community service or professional background, and public or private records including but not limited to law enforcement and court records and personal references as described above.
I agree that Hearts With A Mission may use my name, any photographs and video of me for publicity or promotion purposes without liability or obligation to me.
In consideration of Hearts With A Mission (HWAM) arranging a volunteer assignment for me, and with the intention of binding myself, my heirs, legal representatives, successors and assigns, I hereby expressly RELEASE AND FOREVER DISCHARGE Hearts With A Mission, its officers, directors, employees, volunteers, agents, legal representatives, insurers, successors, and assigns from any and all claims, demands, damages, liabilities, and causes of action that I now have or may in the future have, whether known or unknown, of whatsoever nature, relating to or arising out of my selection as a volunteer by, or my service as a volunteer with, Hearts With A Mission whether or not due to Hearts With A Mission’s negligence, strict liability, or any other breach or fault. This includes, but is expressly not limited to, death, bodily injury, personal injury, property damage, loss or theft of property, economic loss, or any other damage, loss, or cost.
This document shall be construed according to the laws of the state of Oregon. If a dispute should arise with respect to the meaning of any of the terms of this document, the rule of construction that a document is construed against the party preparing such document shall specifically not be applicable to the interpretation of this document.
This General Release represents the entire agreement of the parties hereto and supersedes any and all prior or contemporaneous oral or written understandings, statements, representations, or promises. All of the terms hereof are contractual and not mere recitals.
I acknowledge that I have carefully read this General Release, know and understand the contents thereof, and that this document was freely and voluntarily executed. I acknowledge that I was given the opportunity to seek independent legal counsel on any and all matters herein before I signed this General Release.
Hearts With A Mission
711 Medford Center #334
Medford, OR 97504
529 Edwards St.
Medford, OR 97501
517 Edwards Street
Medford, OR 97501
Transitional Living Programs & Independent Living:
521 Edwards Street
Medford, OR 97501
1504 NE 9th Street
Grants Pass, OR 97526