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(Rev. 03/2021)

I hereby freely, voluntarily, and without duress execute this release under the following terms:

I understand this is a legally-binding release (“Release”) made by me, my parent or legal guardian, if applicable, to Catholic Charities of the Archdiocese of New York and/or Catholic Charities Community Services of the Archdiocese of New York (herein referred to as “Agency”). I understand that I am expected to fulfill my commitments to trainings and the tasks assigned to me. I agree to contact Agency staff if I am unable to participate in an activity for which I have been registered.

ASSUMPTION OF RISK: As a volunteer, I fully recognize that there may be direct, indirect or inherent risks and hazards involved in the activity of volunteering and it is with full knowledge of the facts and circumstances surrounding this activity and to the extent permitted by the laws of the State of New York that I release Agency, the Archdiocese of New York, the Archbishop of New York, its agencies, employees, agents, partners and representatives from any liability whatsoever arising out my participation in any volunteering activity. I also understand that Agency does not require me to participate in any volunteering activity, but I want to do so, despite the possible dangers and risks and despite this Release.

I also agree to assume all of the risks and responsibilities in any way associated and understand that this Release shall bind the members of my family and spouse, if I am alive, as well as my estate, family, heirs, administrators, personal representatives or assigns, if I am deceased, and shall be deemed as a “Release, Waiver, Discharge and Covenant” not to sue Agency. I further agree to save and hold harmless, indemnify and defend Agency, the Archdiocese of New York, the Archbishop of New York, its partners and its representatives from any claim by me or my family, arising out my participation referenced herein. If any term of this Release shall be held illegal, unenforceable, or in conflict with any law governing this Release, the validity of the remaining portions shall not be affected thereby.

I assure Agency that there are no health-related reasons or problems which preclude or restrict my participation as a volunteer and that I have adequate health insurance necessary to provide for and pay for any medical costs that may directly or indirectly result from my participation.

INDEMNITY: In consideration of and return for the services, facilities, and any other assistance provided me by Agency, it is my express intent to indemnify and hold harmless Agency, the Archdiocese of New York, the Archbishop of New York, its representative agencies, and partners, herein releasing Agency, the Archdiocese of New York, the Archbishop of New York and its representatives from any and all liability, claims and/or actions that may arise from injury or harm to me, either from my death or from damage to my property in connection with volunteering with Agency.


CONFIDENTIALITY: I acknowledge that I am prohibited from removing or disclosing confidential or proprietary Agency information of which I may become aware while volunteering with the Agency.  Confidential and proprietary information includes, but is not limited to: (i) consumer or client information; (ii) relationships with businesses and benefactors; (iii) Protected Health Information (“PHI”); (iv) proprietary correspondence and donor financial contributions; (v) financial information, business plans, budgets, revenue, expense figures or projections, and strategy information; and (vi) agreements or other information required by law or contract to be kept confidential.

PHOTO RELEASE: I hereby consent to the taking of photographs, movies, videos, and images capable of reproduction in any medium of me, my children, or children of whom I am the designated guardian by Agency and its parents, affiliates, trustees, directors, members, officers, employees, volunteers, agents and contractors. I hereby grant Agency the right to edit, reproduce, use and re-use said images for any and all purposes including, but not limited to, advertising, promotion, display and marketing and commercial purposes, and I hereby consent to the editing, reproduction, use and re-use of said images in any and all media in existence and all media not yet in existence including, but not limited to, video, print, television and Internet and Pod-Casts.

MEDICAL TREATMENT: I hereby release and forever discharge Agency from any claim whatsoever which arises or may hereafter arise on account of any first aid, treatment, or service rendered in connection with my activities with Agency. AGENCY EXPECTS AND ENCOURAGES EACH VOLUNTEER TO OBTAIN HIS/HER OWN MEDICAL OR HEALTH INSURANCE COVERAGE.

I hereby confirm, represent and warrant that I have never been convicted of or charged with a violent crime, child abuse or neglect, child pornography, child abduction, kidnapping, rape or any sexual offense, nor have I ever been ordered by a court to receive psychiatric or psychological treatment in connection therewith.

By agreeing to this Release, I warrant that I have read and fully understand this Release and I am fully familiar with its contents and terms. I agree to this Release freely and without inducement or assurance of any nature.

IN WITNESS WHEREOF, I am of legal mental capacity to act as my own representative in agreeing to this Release.

Catholic Charities of New York


Catholic Charities Archdiocese of New York
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New York, NY 10022

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