7/25/2019 Release for Unpaid Volunteers and Unpaid Interns 08152011[1]

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The University of North Carolina at Chapel Hill

Office of Human Resources Employment and Staffing Department

RELEASE OF LIABILITY FOR UNPAID VOLUNTEERS AND UNPAID INTERNS

THIS SECTION: APPOINTING DEPARTMENT USE ONLY

Volunteer/Intern Nae Pro!o"e# A$t%&%t': Volunteer Un!a%# Intern

De!artent Nae

De!artent Nu(er I" Volunteer/Intern un#er t)e a*e o+ ,-. (If yes, parent orguardian must sign below.)

ES NO

De"$r%!t%on o+ Volunteer"/Intern" A$t%&%t' or Ser&%$e

!TH"S DESCR"#T"ON $UST $%TCH TH%T ON THE &O'UNTEER RE(UEST )OR$*

THIS SECTION: VOLUNTEER/UNPAID INTERN USE ONLY

INSTRUCTIONS:UNC-CHs mission involves a variety of tea!ing, resear!, and publi servie ativities. "s an unpaid volunteer orunpaid intern, you play an important role in supporting our mission w!ile at t!e same time gaining e#periene w!i! will be personallyrewarding. $or insurane and ris% management purposes, UNC-CH re&uires t!at you arefully read and agree to t!e following terms.'!e term UNC-CH means '!e University of Nort! Carolina at C!apel Hill (along wit! its diretors, offiers, employees and agentsating wit!in t!e ourse and sope of t!eir duties). I, *olunteer+Intern or me means you, t!e intended unpaid volunteer or unpaidintern. e appreiate your interest in serving '!e University of Nort! Carolina at C!apel Hill and welome you as a member of ourommunity

I0 Volunteer/Intern0 )ere(' +reel'0 &oluntar%l' an# 1%t)out #ure""0 e2e$ute t)%" Relea"e o+ L%a(%l%t' un#er t)e +ollo1%n* ter":

,3 " am providing service to UNC+CH voluntarily, -ithout pressure of coercion, for educational, civic, charita.le or humanitarianreasons and -ithout e/pectation of payment, reim.ursement, or future paid employment of any 0ind1

43 " understand that UNC+CH -ill not cover me .y any insurance including, .ut not limited to, medical, property, health, lia.ilityinsurance or -or0ers2 compensation .enefits, nor -ill any financial or other assistance .e provided in the event of in3ury or illness

53 " agree that my service may .e terminated at any time and for any reason .y UNC+CH or .y me1

63 "n consideration of the opportunity to provide unpaid service to UNC+CH, " do here.y release and forever discharge and holdharmless UNC+CH from any and all lia.ility, claims, and demands of -hatever 0ind or nature -hich arise or may hereafter arisefrom my service1 " understand that this Release discharges UNC+CH from any lia.ility or claim that " may have against it -ithrespect to any .odily in3ury, personal in3ury, illness, death, property loss or property damage that may result from my service1

73 " understand and ac0no-ledge that potential ris0s to my health and personal property may .e associated -ith my service toUNC+CH and " voluntarily assume those ris0s1 " release and forever discharge UNC+CH from any claim -hatsoever that arises ormay hereafter arise on account of any first aid, treatment or service " receive in connection -ith my service to UNC+CH1

83 " have consulted -ith my health care provider regarding my pre+e/isting health conditions !such as insect, food or medicationallergies* and -ill provide myself -ith any appropriate medication to treat these health pro.lems1 " here.y release and foreve

discharge UNC+CH from any claim -hatsoever arising from any complication or e/acer.ation of any such health condition193 " grant UNC+CH permission to reproduce my name, li0eness, identity, voice, image, and oral or recorded statement in any

pu.lication or media intended for research, educational, promotional, fundraising or similar purposes -ithout compensation oany 0ind1 " here.y -aive and release UNC+CH from any claim or lia.ility relating to any such use1

-3 " agree to comply -ith all UNC+CH policies ! e.g., the #atent and "nvention, Copyright and %ccepta.le Use #olicies* -hile usingUNC+CH facilities or resources, and " ac0no-ledge that all UNC+CH policies apply to my activities at and service to UNC+CH1

3 This Release of 'ia.ility shall .e .inding and enforcea.le against me and my successors, assignees, heirs, guardians and legalrepresentatives1 " e/pressly agree that this Release is intended to .e as .road and inclusive as permitted .y the la-s of the Stateof North Carolina and that this Release shall .e governed .y and interpreted in accordance -ith the la-s of the State of NorthCarolina1 " agree that, in the event that any clause or provision of this Release shall .e held to .e invalid, the invalidity of suchclause or provision shall not other-ise affect the remaining provisions of this Release -hich shall continue to .e enforcea.le1

I )a&e $are+ull' rea# t)%" Relea"e3 I un#er"tan# t)at %n "%*n%n* t)%" #o$uent0 I a *%&%n* u! "%*n%+%$ant le*al r%*)t" %ne2$)an*e +or (e%n* a(le to "er&e UNC;CH a" an Un!a%# Volunteer or Un!a%# Intern3

444444444444444444444444444444444444 444444444444444444444444444444444444444 4444444444444444Name of &olunteer5"ntern Signature of &olunteer5"ntern Date

444444444444444444444444444444444444 444444444444444444444444444444444444444 4444444444444444Name of #arent or 6uardian Signature of #arent or 6uardian Date!If *olunteer+Intern is under age of /* !If *olunteer+Intern is under age of /*

444444444444444444444444444444444444 444444444444444444444444444444444444444 4444444444444444Name of &olunteer2s5"ntern2s Supervisor Signature of &olunteer2s5"ntern2s Supervisor Date

Revised 75895:;88 E