Eaton Day of Caring Volunteer Registration Form
Welcome to The Bradley Center and thank you for volunteering your time and effort. Your generosity helps in building lives of possibility for the children and adolescents.
Photograph and Publicity Release Form
I, the undersigned, intending to be legally bound, do forever agree and authorize the public use, reproduction, and publication of any photographs for use in public relations, education, advertising, or fund raising, without further consideration or payment. The Bradley Center or its authorized agents in print or advertising materials may use such photographs and any other publication media the agency finds appropriate. All negatives, prints, and electronic files are the sole and exclusive property of Bradley, and I give any right now and in the future, for use by The Bradley Center.
Visitors Confidentiality Agreement
As a visitor to The Bradley Center, I understand that I may see or hear sensitive confidential client, clinical, and/or organizational information while on the premises. If l do receive confidential information while visiting The Bradley Center, I agree to maintain confidentiality and privacy of information as follows:
- I understand that I am about to visit a facility that manages behavioral health care services.
- I understand that people have a right to privacy and confidentiality of sensitive information pertaining to their access to and utilization of mental health assessment and treatment services (as delineated in applicable laws and regulations of the commonwealth and federal government).
- I pledge to maintain and safeguard the confidentiality of all sensitive and privileged client identifying information that I may see or hear while on the premises of The Bradley Center.
- I agree to keep strictly confidential any and all personally Identifiable information about clients (residents and families), practitioners (psychiatrists, psychologists, social workers, and all other health care professional staff), and providers (hospitals, mental health & drug/alcohol treatment facilities, and placement agencies).
- I further pledge to keep in strictest confidence a wide range of sensitive organizational materials and information pertaining to treatment plans, projects, financial and operations details, prospective and past transactions with vendors and other companies/agencies, compilations of business data, employee salary data, and other privileged information.
- I agree to preserve the confidentiality of all such privileged information until disclosure is specifically released in writing.
- When faced with an inquiry from an outside source, whether at work or away from work, and/or whenever I have doubts about disclosure of information, I agree that I will disclose nothing until I have consulted with the Director of Medical Records of The Bradley Center or authorized designee.
Release and Waiver of Liability
This Release and Waiver of Liability, (the “Release”) is executed by and between “Volunteer”, and The Bradley Center, and on behalf of itself, and its parent, subsidiary and affiliated business organizations, and their directors, officers, employees and agents.
In consideration of the Volunteer’s desire to engage in activities related to volunteering of services for one or more local non-profit agencies, the Volunteer does hereby freely and voluntarily, for himself/herself and his/her legal representatives, spouse, heirs and assigns, assume all responsibility for any and all risk of property damage or bodily injury that s/he may sustain while participating in any voluntary activity of any nature, including the use of equipment and facilities at the non-profit agency(s). Volunteer understands that The Bradley Center will not be responsible for any medical costs associated with any injury s/he may sustain. Furthermore, Volunteer does hereby for himself/herself and his/her legal representatives, spouse, heirs and assigns, does hereby release, waive, discharge, and hold harmless The Bradley Center, and all of its parent, subsidiary and affiliated business organizations, and all of their directors, officers, employees and agents from any and all claims which Volunteer or his/her heirs, administrators and assigns ever may have against any of the above for, on count of, by reason of or arising in connection with such volunteer activities or Volunteer’s participation therein, and hereby waives all such claims, demands and causes of action whatsoever, either in law or in equity, arising out of or related to any loss, damage, illness or injury, including death, that may be sustained by Volunteer, or to any property belonging to Volunteer arising from Volunteer’s participation in such volunteer activities, whether caused by negligence or otherwise.
Volunteer expressly agrees that this Release is intended to be as broad and inclusive as permitted by the laws of the State of Pennsylvania, and that this Release shall be governed by and interpreted in accordance with the laws of the State of Pennsylvania. 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 jurisdiction, the invalidity of such clause or provision shall not otherwise affect the remaining provisions of this Release which shall continue to be enforceable.
Further, Volunteer has carefully read the foregoing release and waiver and understands the contents of this Release as his/her own free act and deed, and states that Volunteer is at least eighteen (18) years of age and fully competent.