Volunteer Application

PARTICIPANT AGREEMENT & RELEASE

Including Acknowledgement and Assumption of Risks and Agreements of Release and Indemnity  

I, [FIRST NAME][LAST NAME], participant, in consideration of the services of Phoenix Center/Camp Phoenix acknowledge and agree as follows:

1. Activities and Risks:  Phoenix Center/Camp Phoenix program services (both, referred to as “program” in this agreement) involve a variety of activities including warmups, discussions/debriefings, games, group initiatives (physically and cognitively), therapeutic activities, and moving on, around, and over high and low challenge ropes course elements, zip lines, aerial static ropes courses, and other structures at heights ranging from six inches to fifty feet or more.  The level of participation is always entirely voluntary and a matter of individual choice and for all aspects of the program. Management of risks is an important priority in the facilitation of all levels of programming, however accidents do occur. Risks include risks associated with motor vehicle travel, both to and from program sites and to the site of medical care; all elements of nature, falls, heat stroke, heat exhaustion and lightening; communicable diseases; all diseases associated with exposure to insects, reptiles and animals; errors in judgment, by youth, volunteers, staff, or any contract employee of Phoenix Center/Camp Phoenix; and all other risks associated with all Phoenix Center/Camp Phoenix programs and activities.  Participants may incur cuts, fractures, insect and reptile bites, and trauma from falls or contact with persons, animals (such as horses) or objects; heat and cold from exposure to natural elements, emotional upset or psychological stress, injury, fatigue; and in rare cases, death, including death while in a motor vehicle.  Participants may also experience other risks that may or may not be anticipated by participants and staff. These risks are inherent in Phoenix Center/Camp Phoenix programming and in moving about the facilities where these activities are offered - that is, without such risks the program would lose its value and appeal.

2. Medical Issues & Costs:  Phoenix Center/Camp Phoenix program activities are designed to be physically and emotionally demanding, for participants of average mobility and strength who are in reasonably good health. Certain medical conditions may increase the inherent risks of the experience and cause participants to be a danger to themselves or others. These potentially dangerous conditions include obesity, high blood pressure, cardiac and coronary artery disease, pulmonary problems, pregnancy, arthritis, tendonitis, or other joint and muscular-skeletal problems, seizure disorders, asthma, allergies, diabetes, impaired balance, eyesight, or hearing, and other physical, psychological and psychiatric disorders or other health conditions.  Participants, including Parent/Guardian if the participant is a minor, must carefully consider these issues before choosing to participate, and fully inform Phoenix Center/Camp Phoenix staff of any potentially dangerous condition prior to participating in the program’s activities. By accepting a participant with a disclosed condition, Phoenix Center/Camp Phoenix is NOT representing that it can, or will, successfully manage an event arising out of that condition.  Unless notified otherwise in writing, Phoenix Center/Camp Phoenix will assume that the participant is physically and emotionally capable of participating in all program activities without being a danger to themselves or others. Participants, or Parent/Guardian, understands they are solely responsible for any medical services that Camp Phoenix cannot accommodate. Participant (or their Parent/Guardian) is responsible for the cost of any necessary emergency transportation or medical service for the participant.  

3. Acknowledgment and Assumption of Risks:  I have been informed of and understand the nature of the program offered by Phoenix Center/Camp Phoenix - and its inherent and other risks - and that participation is entirely voluntary. I acknowledge and assume ALL the risks of being enrolled in and participating in the program.  If I am signing this document as a Parent, I have discussed the activities and their risks with my child who understands and wishes to participate, nevertheless. Please notify the Phoenix Center in writing (24 hours in advance of the program date) if there are any specific activities in which the participant can NOT participate.    Release and Indemnity:  I, an adult participant, or Parent of a minor participant (if Parent, for myself and, to the extent allowed by law, on behalf of the minor), hereby agree to release and indemnify (that is, defend and pay or reimburse) Phoenix Center/Camp Phoenix, its owners, officers, directors, employees, volunteers and agents  (the “Released Parties”) with respect to any and all claims, of whatever nature, including for property damage and personal injury, emotional trauma and death, which I or my minor child might incur or cause while enrolled or participating in a program of Phoenix Center/Camp Phoenix. This agreement of indemnity includes claims of members of my, or the child’s, family for losses suffered by me or the child; and claims of third parties, including co-participants, for any injury or loss claimed to be caused in whole or part by me or the child. These agreements of release and indemnity include claims arising in whole or in part from the negligence (but not the gross negligence) of a Released Party. These agreements of release and indemnity include, but are not limited to, claims based in whole or part on the NEGLIGENCE of a Released Party and extend to all costs and attorney’s fees incurred by Camp Phoenix / Phoenix Center. This agreement, including the agreements of release and indemnity, is intended by me to be binding, including on my or the minor child’s estate and heirs, to the fullest extent allowed by law.   

4. Medical Care:  In the event of a medical emergency, Phoenix Center/Camp Phoenix is authorized to provide or obtain such medical care for the participant (minor child or myself), as it deems necessary, at my expense.  

5. Photo Release:  Participant, for him/herself and on behalf of a child, gives permission and consents to the taking of video, photographs, or interviews, and agrees that Camp Phoenix may use such photographs and video in promotional materials produced by Camp Phoenix/Phoenix Center in the future. Yes No 

Phoenix Center/Camp Phoenix reserves the right to exclude anyone from participation, for medical, safety, or other reasons it deems appropriate. I acknowledge that I have been given the opportunity to ask questions regarding any aspect of this agreement, and by signing below I acknowledge that I have read completely and fully understand all aspects of this agreement and agree to its terms.

CONFIDENTIALITY AND NON-DISCLOSURE AGREEMENT

This Confidentiality and Non-Disclosure Agreement (the "Agreement") is made by and between Camp Phoenix / Phoenix Center, a Texas 501c(3) nonprofit corporation ("Company"), and volunteer or employee [FIRST NAME][LAST NAME], an individual and citizen of the United States ("Recipient"), regarding the conditions under which Company will disclose to Recipient certain proprietary and confidential information for the sole purpose of Recipient providing volunteer or professional services to the Company (the "Permitted Use").

1. Protected Health Information. Recipient acknowledges that in the performance of the Permitted Use, it may encounter, view or access certain confidential health information maintained by Company which may qualify as Protected Health Information ("PHI") or electronic PHI, within the meaning of the Health Insurance Portability and Accountability Act of 1996, as amended, and the privacy and security standards promulgated pursuant thereto ("HIPAA"). Under HIPAA, Protected Health Information" or "PHI" means any information, whether oral or recorded in any form or medium, that is created or received from Company and that: (a) relates to the past, present or future physical or mental health condition of an individual, provision of health care to an individual, or the past, present or future payment for health care provided to an individual; and (b) identifies the individual or provides a reasonable basis to believe that it can be used to identify the individual.

2. Definition of Confidential Information.

(a) For purposes of this Agreement, "Confidential Information" shall mean and include any data or information that is deemed proprietary to Company and that which is not generally known to the public, whether in tangible or intangible form, whenever and however disclosed, including, but not limited to: (i) marketing plans, strategies, financial information or projections, operations, sales quotes or estimates, business plans, and performance results, which may be related to the past, present or future business activities of Company; (ii) procedures, schedules, curriculum, presentations, activity and lesson plans, or other plans for products or services, and any customer, vendor or supplier lists related thereto; (iii) scientific or technical information, invention, design, process, procedure, formula, improvement, technology or method; (iv) concepts, reports, data, know-how, works-in-progress, designs, development tools, specifications, computer software, source code, object code, flow charts, databases, inventions, information and trade secrets, trademarks and copyrights; (v) personal information about any child, counselor, volunteer, staff, parent or legal guardian connected with or related to Company; (vi) "Protected Health Information" as defined by HIPAA and described above in Section 1; and (vii) any other information that should reasonably be recognized as confidential information of Company. Confidential Information need not be novel, unique, patentable, copyrightable or constitute a trade secret in order to be designated Confidential Information. Recipient acknowledges that the Confidential Information is proprietary to the Company, has been developed and obtained through great efforts by Company and, as such, the Company regards all of its Confidential Information as trade secrets.

(b) Notwithstanding anything in the foregoing to the contrary, Confidential Information shall not include: (i) information that is demonstrably previously known to Recipient without an obligation of confidentiality; (ii) information that is or becomes publicly known other than through a violation by Recipient of any of its obligations under this Agreement; (iii) information that is rightfully obtained by Recipient from a third party who is not under an obligation of confidence to Company; (iv) information that is independently developed by Recipient, provided that the person(s) developing the same have not had access to the Confidential Information; (v) information that is not considered confidential by Company or found not to be confidential by a court of competent jurisdiction; or (vi) information that must be produced under applicable law or an order of court of competent jurisdiction.

3. Nondisclosure and Nonuse Obligations. Recipient will maintain in confidence and will not, without the prior written consent of Company, disclose, disseminate or use any Confidential Information outside of the Permitted Use or as required by law. Recipient agrees that all use of Confidential Information by the Recipient shall be solely for the benefit of the Company. Recipient shall treat all Confidential Information with at least the same degree of care as Recipient accords its own confidential information. Recipient further represents that Recipient exercises at least reasonable care to protect its own confidential information. Recipient agrees to immediately notify Company if it becomes aware of or discovers any use or disclosure of Confidential Information or PHI in violation of this Agreement, HIPAA, or any other federal, state or local law or regulation. Recipient shall mitigate, to the extent practicable, any harmful effect known to it of a use or disclosure of Confidential Information or PHI by Recipient which is not permitted by this Agreement.

4. No Copies or Photographs. Recipient shall not copy, record, scan, save or download to an electronic storage device, photograph or otherwise reproduce any Confidential Information, in whole or in part, without the Company's prior written consent. During the term of its services with Company, Recipient agrees they will not use any photographic equipment to create capture, or record “still” or video graphic digital or analog images at any time while performing services on behalf of Company, while present on Company property, or while present at the property, home or office of any Company client. For the purposes of this Agreement, photographic equipment shall mean any device capable of creating, capturing, or recording “still” or video graphic digital or analog images including, but not limited to, digital or analog (film) cameras, cellular telephones with cameras, and portable computers with cameras.

5. No Warranty. All Confidential Information is provided by Company "AS IS" and without any warranty, express, implied or otherwise, regarding the Confidential Information's completeness, accuracy or performance.

6. Indemnification. Recipient shall defend, indemnify and hold harmless Company and its officers, directors, employees and any related parties controlled by Company, from and against all demands, threats, claims, suits, proceedings, actions, causes of actions, damages, injuries, judgements, liabilities, obligations, expenses and costs (including costs of litigation and reasonable attorneys' fees) relating or arising out of: (a) a breach of this Agreement by Recipient, including but not limited to any unauthorized disclosure of PHI in violation of HIPAA any other relevant federal, state or local law or regulation; or (b) any action or omission constituting gross negligence or willful misconduct of Recipient in the course of, or connected with, the performance of its duties under this Agreement.

7. Survival and Return of Confidential Information. Recipient understands that its obligations under Paragraph 3 ("Nondisclosure and Nonuse Obligations") and Paragraph 6 ("Indemnification") shall survive the termination date of any relationship between the parties in perpetuity. Upon termination of any relationship between the parties, or upon written request of Company, all tangible Confidential Information in Recipient's possession shall be promptly returned to Company.

8. Governing Law and Costs of Dispute. This Agreement shall be governed in accordance with the laws of the State of Texas without regard to its conflict of law provisions. The parties specifically consent to the courts located in Burnet County, Texas, waive any jurisdictional or venue defenses available to them, and further consent to service of process by mail. In the event a dispute arises under this Agreement, the prevailing party will be entitled to all reasonable costs and expenses incurred by it in connection with such dispute (including attorneys' fees and costs incurred before and at any trial, arbitration or other proceeding), as well as all other relief granted in any suit or other proceeding.

9. Injunctive Relief. Each party acknowledges and agrees that a breach, whether threatened, anticipated or actual, by Recipient of any of the promises or agreements contained herein, will result in irreparable and continuing damage to Company for which there will be no adequate remedy at law, and Company shall be entitled to injunctive relief, and such other relief as may be available at law or equity for such a breach. No bond or other security will be required by Company in connection with the pursuit of such injunctive relief.

10. Binding Effect. This Agreement shall be binding upon and shall inure to the benefit of each party hereto and his, her or its respective successors, heirs, assigns, and representatives.

11. Entire Agreement and Signatures. This Agreement constitutes the entire agreement between the parties with respect to the Confidential Information and supersedes all prior or contemporaneous agreements or understandings between the parties relating thereto. No waiver, modification or amendment of any provisions of this Agreement shall be valid unless made in writing, signed by both parties. This Agreement may be executed in counterparts, each of which shall be deemed an original, but all of which together shall be deemed to be one and the same agreement. A signed copy of this Agreement delivered by facsimile or email shall be deemed to have the same legal effect as delivery of an original signed copy of this Agreement.