The undersigned volunteer (“Volunteer”) agrees to donate services to Santa Clara County Dental Foundation (“SCCDF”) and to perform volunteer functions and assist with events, functions, and activities for SCCDF and ADCF known as the “Silicon Valley Healthy Smiles” project (“SVHS Services”). It is mutually and expressly understood that SVHS Services shall be donated, that Volunteer is not entitled to nor expects any present or future salary, wages, or other benefits for such Silicon Valley Healthy Smiles Services, and that any follow up treatment provided by Volunteer to a patient after the Silicon Valley Healthy Smiles clinic is outside the scope of SVHS Services and Volunteer is solely responsible for such dentist/patient relationship.

In consideration of Volunteer being permitted to perform SVHS Services, Volunteer (i) for himself/herself, his/her spouse, legal representatives, heirs, and assigns (collectively, “Volunteer Parties”), hereby forever unconditionally waives all claims (in law, equity, or otherwise) against SCCDF, America’s Dentists Care Foundation Missions of Mercy (“ADCF”), their respective subsidiaries and affiliates, their respective officers, trustees, officials, employees, and agents, and other volunteer dental service providers, and each of them (collectively, “SVHS Parties”), arising out of, knowingly and voluntarily assumes the risk of, and agrees that SVHS Parties shall not be liable to Volunteer Parties for, any injury to or death of any person, or loss of, injury or damage to, or destruction of any tangible or intangible property, including the resulting loss of use, economic losses, and consequential or resulting damage of any kind from any cause; and (ii) further agrees to undertake to indemnify, defend, and hold harmless SVHS Parties from and against any and all claims, actions, damages, liabilities, costs and expenses (including reasonable attorneys’ fees and expenses), from any cause arising out of or relating to Volunteer’s performance of SVHS Services, including any act, error, omission, or negligence of Volunteer in, on, or about the premises or building at which the SVHS Services are performed.

With respect to the exculpation provided in the foregoing paragraph, Volunteer waives the benefits of California Civil Code section 1542, which provides:

A general release does not extend to claims which the creditor does not know or suspect to exist in his or her favor at the time of executing the release, which if known by him or her must have materially affected his or her settlement with the debtor.

In compliance with the federal and state privacy laws, Volunteer further agrees to hold in confidence all personal and protected health information he/she may overhear or come in contact with during and following the performance of SVHS Services.

Volunteer also grants SCCDF and their respective agents the right to use, without payment of consideration of any kind, his/her picture, voice, and other reproductions of his/her physical likeness in connection with advertising or publicizing SVHS Services and activities in all forms of media in perpetuity.

If Volunteer is a clinical provider, he/she agrees that he/she has all appropriate and active licenses issued by the appropriate licensing authority to provide treatment to patients. Volunteer agrees to perform the SVHS Services in a professional manner and in accordance with all applicable laws, rules, and regulations, including, without limitation, receiving a hepatitis B vaccine as noted below. Volunteer agrees to inform SCCDF of the insurance carrier with whom he/she has a professional liability policy, or if he/she does not have coverage under a professional liability policy, the SCCDF’s professional liability insurance will apply. Any claims arising out of Volunteer’s performance of SVHS Services may be submitted to the appropriate professional liability carrier for further handling pursuant to the terms of the individual’s policy.

If Volunteer is not a clinical provider, he/she must agree to a cursory background check to volunteer for SVHS Services. Volunteer’s acceptance of this agreement signifies that Volunteer gives permission to SCCDF to verify the status of his/her license and his/her background.

Please sign below to acknowledge you understand the statements listed above:

I have read this agreement, including the release and waiver of liability, and fully understand its terms, understand that I will give up substantial rights by signing it and have signed it freely and voluntarily without any inducement, assurance, or guarantee being to me, and intend my signature to be a complete and unconditional release of all liability.