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Volunteer Release and Waiver of Liability

In connection with my voluntary involvement undertaken for National Society to Prevent Blindness – North Carolina Affiliate, Inc. DBA Prevent Blindness North Carolina (hereinafter referred to as PBNC), I hereby agree, for myself, my heirs, assigns, executors, and administrators to release and discharge PBNC, its partners, its officers and directors, employees, agents, volunteers, sponsors, and partners from all claims, demands, and actions for illness or injuries sustained to my person and/or property as a result of my involvement in such activities, whether or not resulting from negligence, and I agree to release and hold PBNC, its officers and directors, employees, agents, volunteers, sponsors, and partners harmless from any cause of action, claim, or suit arising there from.  I hereby attest that my attendance and involvement in such activities is voluntary, that I am participating at my own risk, and that I have read the foregoing terms and conditions of this release.  I also grant PBNC the irrevocable right to use photographs, film, video tape, audio tape, slides, or a combination thereof, in any medium, without pay.

Symptom Screening Checklist

Volunteers will be asked the following questions upon arrival of each volunteer shift.  If a volunteer has been diagnosed with, has symptoms of, or has been exposed to COVID-19, DO NOT come to volunteer.  It is imperative that all shifts be covered, so please locate a substitute to fill the shift and contact PBNC at [email protected] as soon as possible.

  1. Have you had close contact (within 6 feet for at least 15 minutes) in the last 14 days with someone diagnosed with COVID-19, or has any health department or health care provider been in contact with you and advised you to quarantine? 
  • Yes
  • No
  1. Have you had any of these symptoms within the past 24 hours?
  • Fever
  • Chills
  • Shortness of breath or difficulty breathing
  • New cough
  • New loss of taste or smell
  1. Have you been diagnosed with COVID-19 within the past 14 days or are you awaiting the results of a COVID-19 test?
  • Yes
  • No