Thank you for applying as a volunteer at LBJ Community Farm!

You will receive an email with more details about farm volunteering and how to track your time as a volunteer shortly.

Please use the manual sign in sheet (located at the picnic table by the shipping container) to sign in for your first visit after completing this form.

For more details about the Community Farm at LBJ Hospital, contact Farmer Becca Verm at Rebecca.Verm@harrishealth.org  

HARRIS HEALTH SYSTEM
VOLUNTEER INFORMATION
*Are you a  Harris Health, Baylor, UT, MDAnderson Employee?
EMERGENCY CONTACT INFORMATION
VOLUNTEER WAIVER & RELEASE FORM:

Please read this form carefully.    

Note that by signing this Volunteer Waiver and Release Form and participating in the volunteer activities, you will be expressly assuming the risk and legal liability and waiving and release all claims for injuries, damages, or loss which you might sustain as a result of any and activities connected with and associated with the activities.  

I am 18 years of age or older, and am voluntarily performing service for the Harris County Hospital District d/b/a Harris Health System (Harris Health) of my own free will and without any promise or remuneration, compensation, or benefits.  Employees:  I agree not to perform any volunteer service during work hours as an employee of Harris Health and I will not claim, receive or expect to receive any salary, wages, or overtime compensation. I further acknowledge that within the course and scope of my activities as a volunteer, I may be exposed to hazards or risks that may result in my illness, personal injuries, or death whether caused by the fault of myself, Harris Health or other third parties. I understand and acknowledge that this Release discharges Harris Health from any liability or claim that I may have against Harris Health with respect to bodily injury, illness, death, or property damage that may result from the volunteer services I provide to Harris Health or occurring while I am providing volunteer services. It is my express intent that this Release shall bind the members of my family and spouse (if any), if I am alive, and my heirs, assigns and personal representative, if I am not alive, and shall be deemed as a RELEASE, WAIVER, DISCHARGE AND COVENANT NOT TO SUE the above named RELEASEES.  

I understand that the volunteer services I provide to Harris Health may include activities that are inherently dangerous to me, including, but not limited to, the use of digging and trenching devices, lifting and moving up to seventy pounds or more, exposure to harsh chemicals and pesticides, exposure to loud noises and eye, nose and skin irritants, and possible exacerbation of allergies, and contact with disease-carrying insects. In consideration of being permitted to participate in the volunteer activities, I hereby accept any risk to my health, including any injury or death, and property damage that may occur while I am acting within the course and scope of the activity as a volunteer or otherwise participating in the activities. To the best of my knowledge, I can fully participate in this activity.  

 I further understand and acknowledge that Harris Health is not an insurer of my personal safety or property. I UNDERSTAND THAT HARRIS HEALTH WILL NOT BE RESONSIBLE FOR ANY MEDICAL COSTS ASSOCIATED WITH ANY INJURY I MAY SUSTAIN. I further understand that Harris Health does not assume any responsibility for or obligation to provide me with financial or other assistance, including but not limited to medical, health, or disability benefits or insurance.

I grant and convey to Harris Health all right, title, and interests in any and all photographs, images, video, or audio recordings of me or my likeness or voice made by Harris Health in connection with my providing volunteer services to Harris Health.  

As a Volunteer, I expressly agree that this Release is intended to be as broad and inclusive as permitted by the laws of the State of Texas and that this Release shall be governed by and interpreted in accordance with the laws of the State of Texas. I agree that in the event that any clause or provision of this Release is deemed invalid, the enforceability of the remaining provisions of this Release shall not be affected. This Release will not be interpreted against or in favor of any person based upon the fact that the person did or did not write this Release.  

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