The Medical College of Georgia Volunteer Agreement Form

Thank you for agreeing to volunteer your services to the Medical College of Georgia (MCG).  Please affirm your acceptance of the terms of this agreement, stated below, with your signature.

1.       I agree to serve as a volunteer with MCG and the ________________ (insert name of Department or Unit).

2.       I agree that my participation in the activities outlined in the attached Description of Volunteer Duties (which is part of this agreement) is not in exchange for any consideration (e.g., pay, benefits, the promise of future employment).  I acknowledge that, in exchange for my service as a volunteer, I have neither been promised any consideration nor do I expect to receive any consideration. 

3.       I understand that I will not be enrolled as a student at MCG, and that no academic credit will be granted by MCG.

4.       I agree that, as a volunteer, I will not be a MCG employee.  I understand and agree that MCG and I both have the right to end my volunteer relationship with MCG at any time, for any reason, and without advance notice.

• I understand that as a volunteer, I will not be entitled to any employee benefits.  I understand that MCG will not provide me with accident or medical insurance, and is therefore not responsible for any accident or medical expenses that I incur in the course of volunteering.  I also understand that I am not covered by workers' compensation laws in connection with my volunteer affiliation.

• I understand that my participation as a volunteer may involve certain risks which have been explained to me, including but not limited to _________________________________________________________________.  I voluntarily accept these risks.  I release and hold harmless the Board of Regents of the University System of Georgia, the Medical College of Georgia, their members, employees, agents and authorized representatives, from all losses, damages, costs, and expenses, claims, demands, rights and causes of action resulting from any personal injury, death, or damage to property arising out of my volunteer activities

• I agree to abide by all applicable rules and regulations of MCG and any of the department or units where I engage in volunteer activities.  I also agree not to disclose any confidential information concerning patients, research subjects, unpublished research data, and other confidential information of which I may learn in the course of my volunteer service.  I acknowledge and agree that any intellectual property I may create in the course of my activities at MCG shall be the property of MCG. 

 

Volunteer's Signature        _________________________                  Date_______________

 

Volunteer’s Printed Name   _______________________                  Phone______________

*Parent’s Signature   _____________________________                 Date________________

(If the volunteer is a minor, i.e., under 18 years old)

 

Witness’s Signature ______________________________                Date_______________

Witness’s Printed Name   _________________________________________