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KCC Volunteer Participant
Assumption of Risks and Release of Liability
Indemnification
Version dated: March 20, 2004
Functions and Activities
I understand that it is a joy and privilege to participate as a volunteer in tasks that support the mission and vision of Kagyu Changchub Chuling (KCC), a nonprofit Oregon corporation. I am donating my labor, by my free choice, and will perform assigned tasks in a responsible manner.
I acknowledge that certain tasks at the Portland KCC center, and many of the tasks involving construction, repair and maintenance at the Ser Cho Osel Ling retreat lands in Goldendale, Washington, require physical strength as well as competence in operating specific tools or machines. There is risk of injury if the tools, machinery or equipment are not used properly. When accepting a volunteer assignment, I will take into consideration my physical condition, experience and abilities.
I also acknowledge that under some circumstances hazardous conditions (for instance, icy or irregular surfaces) may exist at the center and retreat land, and that such conditions may also exist with man-made structures, equipment and vehicles, even when such equipment or vehicles are not actually in operation.
I also understand that there are risks from other individuals and, of course, many unknown or unanticipated risks.
This release also includes minors under my control.
Release of Liabiliy
Prior to my participation in volunteer activities I acknowledge that there are certain risks associated with these activities, including, by way of example, physical injury due to activity-related accidents, illness or even death. By signing this Release of Liability Form, I expressly warrant that I am capable of withstanding both the physical
and mental demands of these activities. I release Kagyu Changchub Chuling and its teachers, officers and directors, employees, volunteers and agents from any claim I may have against them as a result of injury or illness I may incur
during the course of participation in these activities. This Release of Liability is also intended to cover all claims that members of my family or estate, heirs, representatives or assigns may have against KCC.
Indemnification
I agree to indemnify and hold KCC harmless from any claim made by me or a minor under my control.
I further agree to indemnify and hold KCC and its teachers, officers and directors, employees, volunteers and agents harmless from any and all claims, including but not limited to negligence, arising from my participation in its activities and programs or my presence on the premises.
Please confirm your agreement to this Release by placing your initials in the place provided below. You may include any limitations you negotiate with KCC:
_____"I, the undersigned, agree to the release with KCC as stated above. I negotiated this Release or had the opportunity to do so."
Dated: ____________________
Sign Name: __________________________________
Print name: __________________________________
Address:__________________________________________________
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