Volunteer Release Form
Foster & Adoptive Care Coalition/[RE]FRESH
Name: _________________________________ Phone Number: _____________________________
Emergency Contact: ____________________
Phone Number: _____________________________
I understand that as a volunteer with the Foster & Adoptive Care Coalition and/or [RE]FRESH, I may be asked
to perform physical activities, have contact with unidentified and unfamiliar persons, travel to various
unspecified locations, and encounter other potential risks of injury.
With full knowledge of the risks associated with such volunteer activities, I hereby release, indemnify and hold
harmless the Foster & Adoptive Care Coalition and/or [RE]FRESH and each of its respective employees,
officers, directors, volunteers, agents, agencies and funding sources from all liability and responsibility
pertaining to any claims, demands and actions resulting from my participation in such volunteer activities,
including claims, demands and actions resulting from injuries, physical or mental, or property damage
(including any injury or damage caused by negligence).
I understand that as a volunteer with the Foster & Adoptive Care Coalition and/or [RE]FRESH, information of a
confidential manner may be shared with me, including the identity of children in foster care and their foster
parents. I agree to refrain from sharing this information with anyone outside of the Foster & Adoptive Care
Coalition and/or [RE]FRESH. I understand that release of confidential information to unauthorized persons
may result in personal legal liability, as well as termination of my volunteer assignment.
I also grant the Foster & Adoptive Care Coalition and/or [RE]FRESH permission to utilize my likeness in any
photographs or videos for publicity and other purposes without fee or any claim relating to such photographs or
videos.
I have read the above provisions (or they have been read to me) and I understand them.
Signature: _______________________________
Date: _______________________
If the volunteer is a minor under 18 years of age, the following should be signed by a parent or legal
guardian.
I hereby consent and agree, individually as a parent or legal guardian of ___________________, to all
the terms and provisions stated above.
Signature: _______________________________
Date: _______________________
Relationship to minor: ________________________________________________________________
1750 S. Brentwood Blvd., Suite 210
www.foster-adopt.org
St. Louis, Missouri 63144
314.241.0715
t 800.FOSTER.3
o 314.367.8373
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