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PERMISSION FOR TREATMENT OF VOLUNTEER
By submitting this form, you are stating the following:
I understand that every attempt is made to insure the safety of persons volunteering with NAMI Mississippi. When illness or an accident occurs either at an agency site or in route by agency transportation to a program activity, we will contact the volunteer’s designated emergency contact as soon as possible. There may be times when the designated person cannot be reached soon enough to meet the immediate need.
In the event of an accident or illness requiring emergency medical treatment by a physician or hospital, I hereby authorize the Executive Director (or designee) of NAMI Mississippi to secure necessary treatment on my behalf.
I further agree to assume financial responsibility for such emergency medical treatment not covered by Workman’s Compensation Insurance.
EMERGENCY CONTACT INFORMATION
VOLUNTEER RELEASE FORM
By completing and submitting this form, you are indicating the following:
I hereby release, indemnify, and hold harmless NAMI Mississippi, the Organizers, Sponsors, and Supervisors of all activities from any and all liability in connection with any injury (including any injury caused by negligence), in conjunction with volunteering for NAMI Mississippi. I likewise hold harmless from liability any person transporting me to and from any agency activity. In addition, the agency has permission to utilize for publicity purposes any photographs or videos taken.
By clicking the Submit button, you acknowledge the following: I certify that all information in this application and in any other forms I complete during the application process is true and correct to the best of my knowledge. I understand that if I have provided false information or misrepresented myself, this is sufficient cause for not being accepted as a volunteer.