Please Read this carefully! By signing up to deliver Food for PWM, YOU ACKNOWLEDGE AND AGREE THAT YOU HAVE CAREFULLY READ AND FULLY UNDERSTOOD THE AGREEMENTS AND WAIVER LISTED BELOW AND AGREE TO THE TERMS SET FORTH IN THEM. Photography/Videography Release Form I hereby grant the Project Worhtmore permission to use my likeness in a photograph in any and all of its publications, including website entries, without payment or any other consideration. I understand and agree that these materials will become the property of the Project Worthmore and will not be returned. I hereby irrevocably authorize Project Worthmore to edit, alter, copy, exhibit, publish or distribute this photo for purposes of publicizing the Project Worthmore’s programs or for any other lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph. I hereby hold harmless and release and forever discharge the Project Worthmore from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization. I am 21 years of age and am competent to contract in my own name. I have read this release before signing below and I fully understand the contents, meaning, and impact of this release. If the person signing is under age 21, there must be consent by a parent or guardian. Confidentiality Agreement People that have been displaced may have endured the loss of their home, way of life, and dignity. They may have suffered great tragedies with their families and be dealing with post traumatic stress. They have come to this community to rebuild their lives in keeping with their traditions and individual nature. They have a right to recover their privacy and to determine when and how their stories might be shared with others. Volunteers who work with this program agree to: 1. Respect the privacy of people with whom you are matched. They may not want the stories they share with you to be shared with others. Ask them what you may tell others and what they consider to be private information. 2. Safeguard the confidentiality of displaced people by not making their names, addresses, phone numbers or personal circumstances public in any fashion without their consent. This includes the use of photographs and information in news stories for church bulletins, corporate newsletters and local newspapers. Many people are happy to share their story in the media. But be sure to ask them first. 3. Hold in strict confidence any information of a sensitive nature shared by the case managers. I have read these policies and understand the displaced’s right to privacy and confidentiality. I will fully abide by these policies. Health Risk Acknowledgment Agreement People that have been displaced may have endured the loss of their home, way of life, and dignity. They may have suffered immense tragedies within their families and be experiencing post traumatic stress. In addition, they come from a variety of places in the world with varying health standards and situations. As such, involvement with newly arrived refugees may involve minimal amount of risk to one’s health. Volunteers who work in this program understand that: 1. Project Worthmore and its volunteers are committed to and constrained by the Health Insurance Portability and Accountability Act of 1996, and are therefore respectful of the privacy of each client’s health information. 2. Project Worthmore and others involved in refugee resettlement work diligently to protect the health of the public and the volunteers. 3. Volunteers working with refugees might be exposed to health risks.