RESIDENT WAIVER

Resident Waiver and Release of Liability Form
For Residents Receiving Assistance through Good Neighbors Interlaken

Resident Information
Name:

Address:

Phone:

Email:

Resident Agreement and Liability Waiver

Thank you for reaching out to Good Neighbors Interlaken, a nonprofit neighbor-helping-neighbor program. To protect all involved, we ask that you carefully read and sign this waiver.

  1. Voluntary Participation
    I understand that my participation with GNI in receiving assistance is completely voluntary and that I am not an employee or agent of Good Neighbors Interlaken.

  2. Nature of Activities
    I understand that the services I receive may include driving, light home repairs, errands, companionship, and other non-professional tasks. I will not request services beyond that scope.

  3. Assumption of Risk
    I understand that receiving help through GNI may involve risks, including but not limited to physical injury, property damage, or exposure to illness. I voluntarily assume all risks related to receiving this help, whether known or unknown.

  4. Waiver and Release
    In consideration of being permitted to participate as a participant/resident, I hereby waive, release, and discharge, and hold harmless Good Neighbors Interlaken, and Interlaken Community Action Group (ICAG) and their staff, volunteers, Directors & affiliates from any and all liability, claims, or demands of whatever kind or nature, either in law or in equity, which arise or may arise during the help activities.

  5. Insurance
    I understand that Good Neighbors Interlaken does not provide medical, health, or auto insurance coverage for me. I agree to maintain my own insurance coverage as appropriate and required, including auto insurance, if I am transported by volunteers.

  6. Confidentiality
    I agree to maintain the confidentiality of any personal information about members or other volunteers that I may learn in the course of the help.

    Emergency Contact
    Name:
    Phone:

Acknowledgment
I have read this waiver and release in full. I understand its terms and sign it voluntarily.

Signature:


Date: