The undersigned volunteer (“Volunteer”) agrees to donate services to California Dental Association (“CDA”) the CDA Foundation and to perform volunteer functions and assist with events, functions, and activities for CDA known as the “CDA Cares” project (“CDA Cares Services”). It is mutually and expressly understood that CDA Cares Services shall be donated, that Volunteer is not entitled to nor expects any present or future salary, wages, or other benefits for such CDA Cares Services, and that any follow up treatment provided by Volunteer to a patient after the CDA Cares project is outside the scope of CDA Care Services and Volunteer is solely responsible for such dentist/patient relationship.

 

In consideration of Volunteer being permitted to perform CDA Cares Services, Volunteer (i) for himself/herself, his/her spouse, legal representatives, heirs, and assigns (collectively, “Volunteer Parties”), hereby forever unconditionally waives all claims (in law, equity, or otherwise) against CDA, its subsidiaries and affiliates, their respective officers, trustees, officials, employees, and agents, and other volunteer dental service providers, and each of them (collectively, “CDA Cares Parties”), arising out of, knowingly and voluntarily assumes the risk of, and agrees that CDA Cares Parties shall not be liable to Volunteer Parties for, any injury to or death of any person, or loss of, injury or damage to, or destruction of any tangible or intangible property, including the resulting loss of use, economic losses, and consequential or resulting damage of any kind from any cause; and (ii) further agrees to undertake to indemnify, defend, and hold harmless CDA Cares Parties from and against any and all claims, actions, damages, liabilities, costs and expenses (including reasonable attorneys’ fees and expenses), from any cause arising out of or relating to Volunteer’s performance of CDA Cares Services, including any act, error, omission, or negligence of Volunteer in, on, or about the premises or building at which the CDA Cares Services are performed.

 

With respect to the exculpation provided in the foregoing paragraph, Volunteer waives the benefits of California Civil Code section 1542, which provides:

 

A general release does not extend to claims that the creditor or releasing party does not know or suspect to exist in his or her favor at the time of executing the release and that, if known by him or her, would have materially affected his or her settlement with the debtor or released party.

 

In compliance with the federal and state privacy laws, Volunteer further agrees to hold in confidence all personal and protected health information he/she may overhear or come in contact with during and following the performance of CDA Cares Services.

 

Volunteer also grants CDA, and their respective agents the right to use, without payment of consideration of any kind, his/her picture, voice, and other reproductions of his/her physical likeness in connection with advertising or publicizing CDA services and activities in all forms of media in perpetuity.

 

If Volunteer is a clinical provider, he/she agrees that he/she has all appropriate and active licenses issued by the appropriate licensing authority to provide treatment to patients. Volunteer agrees to perform the CDA Cares Services in a professional manner and in accordance with all applicable laws, rules, and regulations, including, without limitation, receiving a hepatitis B vaccine as noted below. Volunteer agrees to inform CDA of the insurance carrier with whom he/she has a professional liability policy, or if he/she does not have coverage under a professional liability policy, in which case complimentary event coverage may be obtained by applying to TDIC (http://www.cdafoundation.org/give/volunteer/cda-cares-volunteer-dental-program/volunteer-liability-coverage).  Any claims arising out of Volunteer’s performance of CDA Cares Services may be submitted to the appropriate professional liability carrier for further handling pursuant to the terms of the individual’s policy. 

 

By checking box included in the registration form, Volunteer certifies that they have received the hepatitis B vaccination series.

 

If Volunteer is not a clinical provider, he/she must agree to a cursory background check to volunteer for CDA Cares Services. Volunteer’s acceptance of this agreement signifies that Volunteer gives permission to CDA to verify the status of his/her license and his/her background.

 

Please sign below to acknowledge you understand the statements listed above:

 

I have read this agreement, including the release and waiver of liability, and fully understand its terms, understand that I will give up substantial rights by signing it and have signed it freely and voluntarily without any inducement, assurance, or guarantee being to me, and intend my signature to be a complete and unconditional release of all liability.