• Facebook
  • Twitter
Toggle Menu

Komen Upstate NY Volunteer- Information Survey

Question - Required - The Upstate New York area I would like to volunteer in...







Question - Required - Today's Date


I wish to volunteer for the Susan G. Komen Upstate New York Affiliate d/b/a Komen Upstate ("Komen Affiliate"). I understand that my consent to these provisions is given in consideration for being permitted to volunteer for the Komen Affiliate. I understand that the nature of volunteer activities that I may perform in my capacity as a volunteer may involve physical activity, contact with unidentified or unfamiliar persons, or other potential risk of bodily injury or damage to property and I hereby voluntarily assume full and complete responsibility for, and the risk of, any injury or accident which may occur during my volunteer work with the Komen affiliate. to the fullest extent of the law, I, for myself, my next of kin, my heirs, administrators, and executors (collectively, "releasors"), hereby release and hold harmless and covenant not to file suit against (i) the Komen affiliate, the Susan G. Komen Breast Cancer Foundation, Inc.,  the Susan G. Komen Breast Cancer Foundation, Inc. d/b/a Susan G. Komen ("Komen headquarters"), and all other affiliates of Komen headquarters and their respective directors, officers, volunteers, agents and employees; and (ii) all other persons or entities associated with the Komen affiliate or Komen headquarters (collectively, the "releasees") for any injury or damages I might suffer in connection with my volunteer work with the Komen affiliate. this release applies to any and all loss, liability, or claims I or my releasors may have arising out of my volunteer work with the Komen affiliate, including but not limited to, personal injury or damage suffered by me or others, whether such losses, liabilities, or claims be caused by contact with and/or the actions of other persons, contact with fixed or non-fixed objects, negligence of the releasees, risks not known to me or not reasonably foreseeable at this time, or otherwise.
I understand that as a volunteer, I may become privy to confidential information about a Releasee. I agree to maintain the confidentiality of any information marked "confidential" as well as any information about each Releasee's business operations, organizational structure, employee information, financial operations, marketing strategy, organization, donor lists and amounts, plans for upcoming events, current or proposed business transactions and sponsorships, and any proprietary information such as computer software and programming and the like that is not otherwise publicly disclosed. I will not use any confidential information in any manner that would be detrimental to a Releasee.

At all times during my volunteer work with the Komen Affiliate, I will conduct myself in such a manner as not to reflect unfavorably on or in any way diminish the reputation of the Komen Affiliate, Komen Headquarters and its affiliates. I give my consent and permission to the Komen Affiliate, Komen Headquarters and its respective affiliates, successors, licensees, and assigns the irrevocable right to use, for any purpose whatsoever and without compensation, any photographs, videotapes, audiotapes, or other recordings of me that are made during the course of volunteering with the Komen Affiliate.


Visually impaired? Click here to have an audio challenge played.  You will then need to enter the code that is spelled out.
Change image

   Please leave this field empty