GI Smiles - Thank-a-Vet

In consideration of my application and permitting me to participate in this event, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows: (A) Waive, release and discharge from any and all liability for my death, disability, personal injury, property damage, property theft or actions of any kind which may hereafter occur to me including my traveling to and from this event, the following entities or persons: Arizona Dental Foundation and Arizona Dental Association their directors, officers, employees, volunteers, representatives, and agents, the even holders, event sponsors, event volunteers; (B) Indemnify and hold harmless, and agree not to sue the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation in this event, whether caused by the negligence of releases or otherwise. I hereby consent to receive medical treatment that may be deemed advisable in the event of injury, accident and/or illness during this event. By registering for this event, I grant the Arizona Dental Foundation and its agents the right to use my picture, voice, and other reproductions in connection with advertising or publicizing ADF/AzDA and its activities in all forms of media related to this event.

By submitting this form, I understand and agree to the following:

1. Volunteer Role
   I am volunteering my time and services for the Gi Smile Thank-a-Vet program organized by the AzDA Cares Foundation. I understand that all services I provide are on a volunteer basis and I will not receive or expect any wages, salary, or benefits, now or in the future.
2. Assumption of Risk & Release of Liability
   I understand that volunteering with this program involves inherent risks. In exchange for being allowed to participate, I, on behalf of myself and my heirs, waive and release all claims against the AzDA Cares Foundation, Arizona Dental Association, and all affiliated officers, trustees, staff, agents, and volunteers, from any injury, illness, loss, or damages that may occur during or as a result of my participation. I further agree to indemnify and hold harmless these parties from any claims, damages, or expenses arising from my own acts, omissions, or negligence while participating in this volunteer program.
3. Confidentiality
   I will maintain confidentiality regarding all personal or protected health information encountered during or after the program, in compliance with federal and state privacy laws.
4. Media Consent
   I grant permission for the AzDA Cares Foundation to use my name, image, and voice in photographs, videos, or media for event promotion or educational purposes without compensation.
5. Licensing & Background Requirements
   Clinical volunteers must hold valid and active licenses. By submitting this form, I authorize the organizers to verify my license and professional background as applicable.