MCCA Volunteer-Liability Form
Hafa Adai!

Thank you so much for taking interest in gaining some Community Service and/or Service Learning Hours with the Micronesia Climate Change Alliance!

** If you are below the age of 18, please have a parent or guardian fill out this form**
**Please read and enter your name to prove understanding of sections 1-6 below general info**

This Google Form is a binding Volunteer Release and Waiver of Liability Form all volunteers must fill out to participate in any MCCA events or activities.

This Release and Waiver of Liability is to establish a binding contract within the 2022 fiscal year with the Micronesia Climate Change Alliance.
Filling out this Google Form releases MCCA, a non-profit organization and each of its directors, officers, employees, partners and agents. The Volunteer desires to provide volunteer services for MCCA and engage in activities related to serving as a volunteer. Volunteer understands that the scope of Volunteer’s relationship with MCCA is limited to a volunteer position and that no compensation is expected in return for services provided by Volunteer; MCCA 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 MCCA.
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Email *
Volunteer First and Last Name *
Age
School or Organization *
Student Instagram @ (to tag on social media)
Volunteer/Parent/Guardian Contact Number *
Date filling out document *
MM
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DD
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YYYY
**Please read and enter your name to prove understanding in the following sections of this Google Doc** -- 1. Waiver and Release: I, the Volunteer, release and forever discharge and hold MCCA harmless 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 MCCA. I understand and acknowledge that this Release discharges MCCA from any liability or claim that I may have against MCCA with respect to bodily injury, personal injury, illness, death, or property damage that may result from the services I provide to MCCA or occurring while I am providing volunteer services. *
2. Insurance: Further I understand that MCCA 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 MCCA beyond what may be offered freely by MCCA in the event of injury or medical expenses incurred by me. *
3. Medical Treatment: I hereby Release and forever discharge MCCA 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 MCCA *
4. Assumption of Risk: I understand that the services I provide to MCCA may include activities that may be hazardous to me including, but not limited to Fumes, Burns, and other injuries involving inherently dangerous activities such as the use of the Precious Plastics machines. As a volunteer, I hereby expressly assume risk of injury or harm from these activities and Release MCCA from all liability. *
5. Photographic Release: I grant and convey to MCCA all right, title, and interests in any and all photographs, images, video, or audio recordings of me or my likeness or voice made by MCCA in connection with my providing volunteer services to MCCA . *
6. Other: As a volunteer, I expressly agree that this Release is intended to be as broad and inclusive as permitted by the Guam Law and that this Release shall be governed by and interpreted in accordance with the laws of Guam. 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 signing below, I express my understanding and intent to enter into this Release and Waiver of Liability willingly and voluntarily. *
A copy of your responses will be emailed to the address you provided.
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