Volunteer at Vivalon and Change Someone’s Life

I UNDERSTAND THAT IF I AM INJURED IN THE COURSE OF THE PROJECT, I AM COVERED BY Vivalon’s AD&D-TRAVEL ACCIDENT PROGRAM. Coverage is afforded provided that

1.) I am acting at Vivalon’s direction and within the scope of my duties as a volunteer for Vivalon;

2.) The accident takes place during the policy period;

3.) The expenses that are incurred are reported within one year of the date of the accident. Payments will be made regardless of fault (not to exceed the applicable limit of insurance) and include reasonable expenses for:
– First aid administered at the time of an accident;
– Necessary medical, surgical, X-ray and dental services, including prosthetic devices; and
– Necessary ambulance, hospital and professional nursing and funeral services.

I acknowledge that during the course of my volunteer role with Vivalon I will have access to certain information not generally known to the public.

I understand that this information is Confidential Information and agree that it is not to be shared at any time. I understand the need to safeguard, in any format including, but not limited to, database records, email, any other electronic format, hard copy, voicemail or conversation.

I understand that participant records are protected under confidentiality regulations and cannot be disclosed without written consent of the participant, as stated in HIPAA.

1. All Confidential Information provided to or generated by me, both hard-copy and electronic, is highly confidential. It is not to be discussed with anyone not conducting Vivalon business.

2. I agree to protect all Confidential Information when in use, storing it properly when not in use, and discussing it only with those who have a legitimate business need to know.

3. I agree to treat Confidential Information with care during my volunteer role with Vivalon.

4. I will not give data to persons not authorized to access it. I understand that Vivalon expressly forbids the disclosure of private data or the distribution of such data in any medium, except as required by my volunteer duties and responsibilities.

5. I understand that if I am found compromising information that I may be released in my volunteer role with the organization.

We ask that each Volunteer and Member review, and sign this COVID-19 Liability Waiver prior to participating in any in-person services or programs with Vivalon. The signed waiver will be kept with the confidential Volunteer/Member file.


1. I affirm that neither I, nor anyone in my immediate household is currently diagnosed with, demonstrate any symptoms of, or have in any way been exposed to any communicable diseases, including the novel coronavirus known as COVID-19.

2. I agree that I will immediately notify Vivalon if I or anyone in my immediate household is diagnosed with the novel coronavirus known as COVID-19. I understand that this notification requirement is critical to limit the spread of the virus.

3. I acknowledge that I am aware that by engaging in Vivalon volunteer activity that there are inherent risks of being exposed to COVID-19. I am also aware that such exposure can occur directly or indirectly.

4. I understand that certain individuals may be more susceptible to becoming seriously ill if they contract COVID-19, including people over the age of 65, people with serious underlying health conditions, including high blood pressure, chronic lung disease, diabetes, obesity, asthma, and those whose immune systems are compromised. I understand that if I or a household member fall within one or more of these categories, there could be a greater risk that I should discuss with my health care provider.

5. I understand that while Vivalon strives to provide safe volunteer activities by providing protocols intended to reduce the risk of COVID-19, Vivalon cannot eliminate all risks. By signing this Waiver, I ASSUME ALL RISKS regarding the possibility of contracting the novel coronavirus known as COVID-19 or any mutation or variation thereof.

6. I agree to indemnify, defend and hold Vivalon harmless from all responsibility and liability against any and all damages, costs, expenses, and fees (including without limitation attorney fees and costs) arising from any illness or death that may occur as a result of my active participation with Vivalon. I, for myself, my executors, my heirs, and insurance companies fully and forever release and discharge Vivalon, its officers, volunteers, agents, representatives, donors, and successors from any loss, cost, damages, or other liability which I may incur due to my participation with Vivalon.

By my signature below, I acknowledge that I accept the conditions of this liability waiver, freely and without coercion. It also denotes my desire to continue my participation with the services and activities provided
by Vivalon.

If I am applying to volunteer, which will involve driving my own vehicle or a company vehicle on behalf of Vivalon, I hereby authorize Vivalon’s insurance company and/or Heffernan Insurance Brokers to be in possession of my driver’s license number, obtain the necessary motor vehicle records and authorize them to send a copy of my Motor Vehicle Record to Vivalon.