Safe Harbor Ohio Release and Waiver of Liability Form & Non-Disclosure Agreement

The Release and Waiver of Liability & Non-Disclosure Agreement (the "Release”) executed by the undersigned (hereinafter referred to in the first person as “I” and “me” or the “Party”), releases Safe Harbor Ohio, Inc., an IRS 501c3 approved nonprofit corporation organized and existing under the laws of the State of Ohio and each of its directors, officers, and employees (hereinafter “Safe Harbor”). The Party may desire to provide volunteer services for Safe Harbor and engage in activities related to serving as a volunteer. The Party may simply be visiting/taking a tour of the Safe Harbor property, or the Party may refer to Safe Harbor staff.

Except as otherwise provided for in a separate agreement, I understand that the scope of my relationship with Safe Harbor is as a volunteer and/or visitor, and that no compensation is expected in return for any services that I may provide; that Safe Harbor will not provide to me any benefits traditionally associated with employment; and that I am responsible for my own insurance coverage in the event of personal injury or illness as a result of any services I may provide to Safe Harbor.

Waiver and Release: I release and forever discharge and hold harmless Safe Harbor and its successors and assigns from any and all liability, claims, and demands of whatever kind or nature, either in law or in equity, which arise or may hereafter arise from my being on Safe Harbor property, including any liability that may arise out of the negligence or carelessness on the part of Safe Harbor, its directors, officers, employees, or volunteers. I understand and acknowledge that this release discharges Safe Harbor from any liability or claim that I may have against Safe Harbor with respect to bodily injury, personal injury, illness, death, or property damage that may result from being on Safe Harbor property and/or my providing services or for the benefit of Safe Harbor.

Insurance: Further, I understand that Safe Harbor 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 of any nature in the event of injury, illness, death, or damage to property. I expressly waive any such claim for compensation or liability on the part of Safe Harbor in the event of such injury or medical expenses incurred by me.

Medical Treatment: I hereby Release and forever discharge Safe Harbor from any claim whatsoever which arises or may hereafter arise on account of any first-aid treatment or other medical treatment or services rendered in connection with an emergency or incident during my time on the Safe Harbor property duties.

Assumption of Risk: I understand that the services I provide to Safe Harbor may include activities that may be hazardous to me. I hereby voluntarily and expressly assume the risk of injury or harm from these activities and release Safe Harbor from any and all liability for injury, illness, death, or property damage resulting during my time on the Safe Harbor property.

Photographic and Copyright Release: I grant and convey to Safe Harbor all rights, titles, and interests in any and all photographs, images, video or audio recording of me or likeness or voice made by Safe Harbor in connection with my visit to Safe Harbor. I further grant and convey to Safe Harbor all right, title, and interests in any and all works, including but not limited to publications, photographs, images, video, audio recording taken and/or produced by me in connection with the services and or visit to Safe Harbor.

Confidentiality Policy: I agree that any content of Safe Harbor’s treatment programs, confidential information regarding Safe Harbor, including, but not limited to participant records or information, the location of Safe Harbor, driving directions to Safe Harbor, or case information, work, or other records relating to Safe Harbor, and the like, shall be considered and kept as the private and privileged records or information of Safe Harbor and will not be divulged to any person, firm, corporation, or any other entity except on the direct authorization of the Executive Director of Safe Harbor. Further, upon leaving the Safe Harbor property I agree that I will continue to treat as private and privileged any knowledge concerning the same and will not release any such information to any persons, firm, corporation or other entity, either by statement, deposition, or as a witness except upon direct written authority of the Executive Director of Safe Harbor, or an order of a court of competent jurisdiction. Safe Harbor shall be entitled to an injunction by any court of competent jurisdiction to enjoin and restrain the unauthorized disclosure of such information.

Further Agreeance: I expressly agree to obey all rules developed by Safe Harbor and agree that I may be removed from participating or otherwise volunteering in Safe Harbor activities and that I may be asked to leave Safe Harbor property at any time or for any reason that Safe Harbor’s Executive Director or other authorized employee deems adequate. I agree not to use or be under the influence of any narcotic or other controlled substances or any kind or be under the control of any alcoholic beverages either on Safe Harbor property or immediately prior to entering Safe Harbor Property.

Other: I expressly agree that this Release is intended to be as broad and inclusive as permitted by the laws of the State of Ohio and that this Release shall be governed by and interpreted in accordance with the laws of the State of Ohio. I agree 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. The venue of any dispute that may arise out of this Release, or otherwise, between the parties to which Safe Harbor, its employees, directors, or officers, are a party will be the Common Pleas Court for any County in which Safe Harbor has physical facilities.

BY SIGNING BELOW, I EXPRESS MY UNDERSTANDING AND INTENT TO ENTER INTO THIS RELEASE AND WAIVER OF LIABILITY WILLINGLY AND VOLUNTARILY.