Lubeck Fellowship Program

Application

PURSUE YOUR
PASSION

PROVIDE A PERSONAL STATEMENT, DESCRIBING YOUR BACKGROUND, INTERESTS, STRENGTHS, CAREER GOALS AND HOW YOU WOULD BENEFIT FROM THE FELLOWSHIP:

LIST ALL PROFESSIONAL AND VOLUNTEER WORK EXPERIENCES, INCLUDING DATES OF SERVICE:

Release and Waiver
Volunteer (and Guardian) expressly understands and agrees that they are not an employee of Chai Lifeline and they will not receive any compensation or remuneration of any kind for services or duties performed therein.  
Volunteer (and Guardian) does hereby release and forever discharge and hold harmless Chai Lifeline its directors, officers, employees, agents, successors, and assigns (collectively, Chai Lifeline, Inc. from any and all liability, claims, and demands of whatever kind or nature, either in law or in equity, which arise or may hereafter arise from any and duties and functions required in the administration of Volunteer€™s position and such other duties, functions and responsibilities as are otherwise directed or specified by Chai Lifeline from time to time (the "Activities").  
Volunteer also expressly waives any claim for compensation, whatsoever, including Disability Benefits or liability on the part of Chai Lifeline for such services as a Volunteer.
Assumption of Risk  
Volunteer (and Guardian) understands that the Activities (and any necessary preparation or transport in connection with such Activities) may pose hazards and dangers, from time to time, be inherently dangerous and may expose Volunteer to a variety of foreseen and unforeseen hazards and risks.  Volunteer therefore acknowledge that by participating in any such Activities, Volunteer has considered those risks and Volunteer (and Guardian) hereby expressly and specifically assumes the risk of injury or harm in the Activities and releases Chai Lifeline from all liability including that for all injuries, illness, death, or property damage resulting from the Activities and/or Volunteer's negligence.  Volunteer (and Guardian) also agrees to indemnify Chai Lifeline to the fullest extent permitted by law for any injury resulting from Volunteer€™s negligent or intentionally tortuous acts and/or omissions. 
Medical Treatment  
Volunteer (and Guardian) understands that this Release discharges Chai Lifeline from any liability or claim that the Volunteer (or Guardian) may have against Chai Lifeline with respect to any bodily injury, personal injury, illness, death, or property damage that may result from Volunteer's Activities with Chai Lifeline, whether caused by the negligence of Chai Lifeline or its officers, directors, employees, agents, or otherwise.   
Volunteer (and Guardian) does hereby release and forever discharge Chai Lifeline from any claim whatsoever that arises or may hereafter on account of any first aid, treatment, or service rendered in connection with the Volunteer's Activities with Chai Lifeline or with the decision by any representative or agent of Chai Lifeline to exercise the power to consent to medical or dental treatment as such power may be granted and authorized in this release.    
Insurance   
Volunteer (and Guardian) understands that, except as otherwise agreed to by Chai Lifeline in writing, Chai Lifeline does not carry or maintain health, medical or disability insurance coverage for any Volunteer. Each volunteer is expected and encouraged to obtain his or her own medical or health insurance coverage.  
Volunteer (and Guardian) also understands that Chai Lifeline does not assume any responsibility for or obligation to provide financial assistance or other assistance, including but not limited to medical, health, or disability insurance in the event of injury or illness.   
Photographic Release  
Volunteer (and Guardian) does hereby grant and convey unto Chai Lifeline the perpetual, nonexclusive, transferable right to use, reproduce, transmit, display, perform, prepare derivative, works from, distribute, and authorize the redistribution of any and all photographic images and video or audio recordings made by Chai Lifeline during the Volunteer's Activities with Chai Lifeline. Additionally, I hereby grant title and interest in such images, video or audio recordings, including, but not limited to, any royalties, proceeds, or other benefits.    
Confidentiality  
Volunteer (and Guardian) understands that in the course of their contacts with families served by Chai Lifeline, Volunteer might learn privileged and confidential information that is of a highly personal nature. Examples of such information might be but are not limited to; medical condition and treatment, finances, living arrangements, employment, identifying information and relationships among family members.  
Volunteer (and Guardian) understands that all such information must be treated as confidential.  
I agree not to disclose confidential information to any person or entity for any reason or purpose whatsoever, except when authorized to do so on writing.  I will also make certain that any disclosures are made in a private setting in which no one can overhear any information that is conveyed. I understand unauthorized disclosures are considered grounds for immediate termination of volunteer status.  
Background Check 
I authorize Chai Lifeline and/or its agents to make an investigation of my background, references, employment, education, and criminal history record information which may be in any state or local files, including those maintained by both public and private organizations, and all public records, for the purpose of confirming the information contained in my application and/or obtaining other information which may be material to my qualifications for placement as a volunteer. This authorization shall remain in effect for as long as I remain an Employee or Volunteer.   
I will report any changes in my criminal history to Chai Lifeline. 
If I am no longer an Employee or Volunteer as a result of any investigative report resulting from this authorization, Chai Lifeline will provide me a copy of that report along with a summary of my rights under the Fair Credit Reporting Act. 
Other  
Volunteer (and Guardian) expressly agrees that this Release is intended to be as broad and inclusive as permitted by the local and state laws, and that this Release shall be governed by and interpreted in accordance with the local and state laws.  
Any dispute arising out of or relating to this agreement, its interpretation or application, or the breach thereof, shall be settled by arbitration by Chai Lifeline€™s designated Bais Din as selected by the Board of Directors of the Organization, which may be amended from time-to-time and without notice. 
I am aware that Chai Lifeline reserves the right to terminate or modify the conditions of my participation in Chai Lifeline Activities, including dismissal from Chai Lifeline, at any time, for any reason, with or without cause, notice or liability.
I AGREE TO THESE TERMS AND POLICIES
Lubeck Fellowship Program

Application

PURSUE YOURPASSION

PROVIDE A PERSONAL STATEMENT, DESCRIBING YOUR BACKGROUND, INTERESTS, STRENGTHS, CAREER GOALS AND HOW YOU WOULD BENEFIT FROM THE FELLOWSHIP:

LIST ALL PROFESSIONAL AND VOLUNTEER WORK EXPERIENCES, INCLUDING DATES OF SERVICE:

PURSUE YOUR
PASSION
