Volunteer Waiver, Release, and Indemnity Agreement Between Mile High Behavioral Healthcare and “the volunteer”) This document sets forth the responsibilities and understandings of the volunteer and of Mile High Behavioral Healthcare regarding volunteer’s participation in volunteer programs partially or wholly coordinated by Mile High Behavioral Healthcare (hereinafter “the organization”). The volunteer and Mile High Behavioral Healthcare agree as follows: 1. The volunteer performs the service of the volunteer’s own free will, without promise, expectation, or receipt of remuneration. The volunteer is not an employee or agent of organization for any purpose and the volunteer’s services are not controlled nor mandated by organization. 2. If the volunteer is under the age of 18, the volunteer may only participate in volunteer service with the express written consent of the volunteer’s parent or guardian. 3. The volunteer understands and agrees that it is possible that the volunteer may be injured or otherwise harmed during volunteer service due to accidents, acts of nature, the volunteer’s negligent or intentional acts, or the negligent or intentional acts of others; that while organization has taken some steps to reduce the chances of injuries or harm to the volunteer, that organization has no control over most risks, and, thus, cannot and does not guarantee nor take any responsibility for the safety of the volunteer or the volunteer’s property while the volunteer is engaged in volunteer service; and that the volunteer must take full responsibility for himself or herself and assume the risk of harm or damage while serving by taking all necessary and reasonable precautions and acting in a manner that will help protect himself or herself and his or her property. 4. The volunteer agrees to waive and release organization from any and all potential claims for injury, illness, damage, or death which the volunteer may have against organization that might arise out of the volunteer’s service and to hold organization harmless there from. 5. The volunteer agrees and understands that injuries or losses to others, such as co-workers or the person(s) being helped, may occur as a result of the volunteer’s negligent or intentional acts during volunteer service, and that to avoid such harm, the volunteer must exercise care and act responsibly in serving others. 6. If any injury or loss to another does occur due to the volunteer’s intentional actions or due to volunteer’s negligent actions arising outside of the scope of the volunteer’s activities, the volunteer must accept the liability for and repair, or make reparations for, the harm done. 7. Organization is not providing the volunteer with insurance coverage for any injuries, conditions, or losses to the volunteer arising out of volunteer activities, except that organization does provide liability insurance coverage on all organization vehicles used during service projects. 8. The volunteer must maintain his or her own primary medical insurance and the volunteer’s own automobile liability insurance when driving a non-organization vehicle to cover potential medical and other costs related to the volunteer service; and the volunteer is also encourages to maintain property and life insurance coverage while serving as a volunteer. 9. All costs for injury or loss above the coverage provided by the volunteer’s insurance are the volunteer’s personal responsibility.Since volunteers are not organization employees, organization does not provide worker’s compensation coverage for injuries or illnesses to the volunteer arising out of volunteer activities. 10. Organization will provide you with a legal defense, upon your request, in response to any claim or action brought against you, arising out of your volunteer service in a program that organization helps coordinate, where you were acting in good faith and reasonably believed you were acting within the scope of the volunteer activity, and the act in question was not an intentional or knowing act constituting illegal, willful, or wanton misconduct. However, organization will not defend you in any case where the injury resulted from your operations of a non-organization motor vehicle, vessel, aircraft, or other vehicle for which a pilot or operator’s license is required or where the suite is brought by an authorized governmental officer to enforce a federal, state, or local law. 11. In legal actions in which organization provides your defense, organization will pay for reasonable attorney fees, judgments, settlements, or other expenses directly related to your defense only up to the limits presently stated in the appropriate State statutes, one time only per volunteer. Organization will control the defense and you must reasonably cooperate and comply with organization decisions and procedures. 12. As a volunteer of Mile High Behavioral Healthcare, you are required to follow the Federal Law and Confidentiality Regulations to protect client confidentiality. No one in connection with this agency may disclose any information about the client or client contact with this agency unless the following conditions exist: a. The client gives consent in writing; b. A court order exists for such disclosure c. In the case of medical or psychiatric emergency, this information will be disclosed to qualified personnel. It is a crime to violate the Federal Law and Regulations and you have the right to report suspected violations to the appropriate authorities. Federal laws and Regulations do not protect any information about client involvement with child abuse or neglect. This agency has a “duty to report” any such suspicions to the state and local authorities. See 42 U.S.C. 290dd-3 and 42 U.S.C. 290ee-3 for Federal Laws and 42 C.F.R. Part 2 for Federal Regulations. Federal Laws and Regulations do not protect any information about a crime committed by a client at either the program or against any person who works for the program or any threat to commit such a crime. 13. I, hereby give Mile High Behavioral Healthcare and its employees, representatives, and authorized media organizations permission to print, photograph, and record myself for use in audio, video, film, or any other electronic, digital and printed media. This includes use of my name. I have read all of the above and agree to abide by the aforementioned guidelines.