Day of Caring Photo/Video/Liability Release

2015 NPODC Liability Release Form

This form must be completed by each volunteer and non-profit staff member
Fields with asterisk (*) are required.




Daytime Address*:

City*: State*: Zip*:

Personal Phone*: Type*:

Work Phone*:

Liability Release
I hereby release United Way of Greater Topeka (as well as its successors and assigns) from any and all claims for damages, whether to person or property, arising from any accidents or injuries, direct or indirect, which are caused or arise from my participating in United Way Day of Caring.

Photo/Video Release
I hereby give to United Way of Greater Topeka, to its nominees, agents, assigns and to the photographer, my free and unlimited consent and permission, waiving all claims for any compensation by reason thereof or for damages by reason thereof, to use, publish/broadcast, republish/rebroadcast or exhibit in the furtherance of its work, with or without identification of me by name, the photographs & video taken during my participation in United Way Day of Caring.

By typing my name I agree to the above conditions and statements regarding the Liability and the Photo/Video Release:

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