Your informationRequired fields are marked with an asterisk (*).
Please summarize your professional/career experience:
Indicate areas where you could provide expertise to a Mentee. (Check all that apply)
Please list any additional qualities, skills or other attributes you feel you have that would benefit a mentee
Please describe your experience in any formal or informal mentoring relationship
Describe your goals/expectations for the mentoring program
Please describe your ideal Mentee
Is there anything else you would like us to consider when matching you with a mentee?
Availability: Best days to contact
Availability: Best Time to contact
Please read and check each numbered box to agree *
Full Name *
Dress for Success Southern Nevada Volunteer Release and Waiver of Liability Form
This Release and Waiver of Liability (the “release”) executed on today's date, by "Volunteer"(*Digital Signature), releases Dress for Success Southern Nevada(DFSSN), a nonprofit corporation organized and existing under the laws of the State of Nevada, and each of its directors, officers, employees, and agents. The Volunteer desires to provide volunteer services for DFSSN, and engage in activities related to serving as a volunteer.
Volunteer understands that the scope of Volunteer’s relationship with DFSSN is limited to a volunteer position and that no compensation is expected in return for services provided by Volunteer; that DFSSN will not provide any benefits traditionally associated with employment to Volunteer; and that Volunteer is responsible for his/her own insurance coverage in the event of personal injury or illness as a result of Volunteer’s services to DFFSN.
1. Waiver and Release: I, the Volunteer, release and forever discharge and hold harmless DFFSN and its successors and assigns from any and all liability, claims, and demands of whatever kind of nature, either in law or in equity, which arise or may hereafter arise from the services I provide to DFFSN. I understand and acknowledge that this Release discharges DFSSN from any liability or claim that I may have against DFSSN with respect to bodily injury, personal injury, illness, death, or property damage that may result from the services I provide to Nonprofit or occurring while I am providing volunteer services.
2. Insurance: Further I understand that DFSSN 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. I expressly waive any such claim for compensation or liability on the part of DFSSN beyond what may be offered freely by DFSSN in the event of injury or medical expenses incurred by me.
3. Medical Treatment: I hereby Release and forever discharge DFSSN from any claim whatsoever which arises or may hereafter arise on account of any first-aid treatment or other medical services rendered in connection with an emergency during my tenure as a volunteer with DFSSN.
4. Assumption of Risk: I understand that the services I provide to DFSSN may include activities that may be hazardous to me including, but not limited to lifting and climbing a ladder. As a volunteer, I hereby expressly assume risk of injury or harm from these activities and Release DFSSN from all liability.
5. Photographic Release: I grant and convey to DFSSN all right, title, and interests in any and all photographs, images, video, or audio recordings of me or my likeness or voice made by DFSSN in connection with my providing volunteer services to DFSSN.
6. Other: As a volunteer, I expressly agree that this Release is intended to be as broad and inclusive as permitted by the laws of the State of Nevada and that this Release shall be governed by and interpreted in accordance with the laws of the State of Nevada. 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.
By digitally signing below, I express my understanding and intent to enter into this Release and Waiver of Liability willingly and voluntarily with Dress for Success Southern Nevada
*Digital Signature (Or parent/guardian if under 18)