• The Alaska Mission of Mercy Volunteer Service Agreement – please read, when you register you will acknowledge having read and agreeing to the terms of the Agreement
• The AKMOM Volunteer Registration link – click on the Volunteer Registration button below to register
By reading and acknowledging this agreement in the volunteer registration, on behalf of myself, my personal representatives, heirs, assigns and anyone else entitled to claim through me, I do hereby waive any right of recover, and release the Alaska Dental Society (ADS), the Alaska Mission of Mercy (AKMOM), Alaska Dental Society Charitable Activities Fund (ADSCAF) their officers, trustees, officials, employees and agents, and other volunteer dental service providers from liability related to, arising from any and all injury to persons and damage to property, and further agree to undertake to indemnify, hold harmless and defend the ADS, the AKMOM, ADSCAF from and against any and all claims, damages, actions, liability and expenses including attorney’s fees and other professional fees in connection with bodily injury including death, personal injury and/or damage to property arising from or out of the volunteer’s activities and participating in volunteer services at Alaska Mission of Mercy.
I further acknowledge and agree that the ADS, the AKMOM, ADSCAF do not assume any responsibility whatsoever for any property of the volunteer, and the volunteer shall not hold the Alaska Dental Society or Alaska Mission of Mercy liable for any loss or damage to same.
In compliance with the HIPAA Privacy Act: I further agree to hold in confidence all personal and protected health information I may overhear or come in contact with during and following Alaska Mission of Mercy.
I also grant the ADS, the AKMOM, ADSCAF and their agents the right to use, without payment of consideration of any kind, my picture, voice and other reproductions of my physical likeness in connection with advertising or publicizing ADS, the AKMOM, ADSCAF services and their activities in all forms of media in perpetuity.
All clinical providers rendering oral health treatment services must have all appropriate and active licenses issued by the appropriate licensing authority to provide treatment to AKMOM patients. All other volunteers must agree to a cursory background check to volunteer for the AKMOM project. Your acceptance of the Alaska Mission of Mercy Volunteer Service Agreement signifies that you give permission to the ADS, the AKMOM, ADSCAF to verify the status of your license and your background.