PHOTO RELEASE, CONFLICT OF INTEREST, & COVID

Name *

First

Last

Email *

Date *

THE BELOW FORMS WILL REMAIN ACTIVE UNLESS PGI IS NOTIFIED IN WRITING OF CHANGES.

COVID POLICY

Before training session: Clients/ trainer/caregivers with high risk factors should talk to their doctor and consider risks. Training session should be re-scheduled/cancelled if anyone: Has been sick with common cold-like symptoms (fever, cough, runny nose, scratchy/sore throat etc…) or conjunctivitis (i.e. pink eye) or has a positive covid test. If one feels they may be sick, it is the volunteers responsibility to contact PGI and notify them before arriving at a training outing, session or event. Clients/Volunteers/Staff will have the choice to wear masks at all times. *

I agree

Signature *

UNDERSTANDING OF RISK

By signing below I agree that I am personally responsible for my safety and actions while volunteering and working with Paws Giving Independence (PGI). I agree to comply with all PGI’s COVID policies and rules, including but not limited to all PGI policies, guidelines, and instructions with COVID19. I am sufficiently informed about the risks involved in participating with PGI. * *

I agree

Signature *

PHOTO RELEASE

Photo Release *

I hereby authorize and grant permission to Paws Giving Independence to reproduce my first name and/or photographic image, and/or any video footage of me, provided such photograph or video shall have been taken by Paws Giving Independence, or obtained by them either from me or with my consent. I agree that such reproduction may be edited as desired. I consent to the use of my first name, photographic image, video footage and biographical material about me in any promotional materials. I represent that I have the right to enter into the Agreement and that my rights I have granted in this Agreement will not violate any commitment or understanding I have with any other person or entity. I agree to indemnify and hold harmless Paws Giving Independence, its officers, members, executors, assigns, and/or any other parties or entities employed by it in relation to the usage of the aforesaid information against all claims, losses, expenses and liabilities of every kind including reasonable attorney’s fees, arising out of the inaccuracy or breach of any provision of this Agreement. I expressly release Paws Giving Independence, its officers, members, executors, assigns, and/or said other parties or entities from any and all claims arising out of the use of my first name and/or photographic image and/or video footage. This Agreement represents the entire understanding of the parties and shall be permanent unless revoked by me in writing. Should I wish to revoke this agreement, I may do so by writing to Paws Giving Independence at PO BOX 9572, Peoria, IL 61612-9572.
I do NOT authorize PGI to use my photo. I have notified PGI in writing of my request. via email to myuen@givingindependence.org

Signature

CONFLICTS OF INTEREST

CONFLICTS OF INTEREST *

CONFLICTS OF INTEREST ACKNOWLEDGMENT AND DISLOSURE FORM I have read the conflicts of interest and confidentiality policy set forth above and agree to comply fully with its terms and conditions at all times during my service with Paws Giving Independence. If at any time following the submission of this form I become aware of any actual or potential conflicts of interest, or if the information provided below becomes inaccurate or incomplete, I will promptly notify the Paws Giving Independence NFP Board of Directors in writing.

Signature *

THE BELOW FORMS WILL REMAIN ACTIVE UNLESS PGI IS NOTIFIED IN WRITING OF CHANGES.

COVID POLICY

UNDERSTANDING OF RISK

PHOTO RELEASE

CONFLICTS OF INTEREST

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