Please Note
Applying for services is a 2-step process. Your case cannot be processed until you have completed both steps.
Step 1 – Complete and submit this form.
Step 2 – You will be instructed to complete additional forms and provide supporting documents for eligibility verification.
Please follow the instructions carefully on the page after you submit this online application.
IMPORTANT
You must submit all required documents within two weeks of submitting this application or your case may be denied.
Confidentiality Agreement Terms and Conditions
In consideration of my volunteering with Community Action Council of Howard County, Maryland, Inc. (CAC), I (Volunteer) agree to the following:
Volunteer Waiver and Release of Liability Terms and Conditions
I (“Volunteer”) agree to conduct myself in a professional manner as a representative of CAC, to serve as a volunteer for Community Action Council of Howard County, Maryland, Inc. (CAC) and engage in the activities and duties related to being a volunteer. I hereby freely, voluntarily, and without duress execute this Release Agreement under the following terms and conditions:
I understand that I will serve at the pleasure of Community Action Council of Howard County, Maryland, Inc. (CAC) or their designee and may be dismissed from volunteer duties at any time, with or without cause. I retain a similar right to terminate my relationship with CAC at any time for any reason. Furthermore, it is understood that as a volunteer I may or may not be selected for certain volunteer services, the determination of which shall be made at the sole discretion of CAC.
Release and Waiver: I hereby release and forever discharge and hold harmless CAC, its agents, representatives, employees and its successors and assigns from any and all liability, claims and demands of whatever kind or nature, either in law or in equity, which arise or may hereafter arise from my volunteer activities with CAC.
Medical Treatment: I hereby release and forever discharge CAC, its agents, representatives and employees, from any and all claims, liability for injury, illness, death, or property damage resulting from the activities I partake in or that my volunteer child partakes in to myself or to my volunteer child. I understand that CAC does not assume responsibility for or obligation to provide financial assistance or other assistance, including but not limited to medical, health or disability insurance in the event of injury or illness. I also understand and acknowledge that as a volunteer I am not covered by Workers’ Compensation insurance or benefits provided hereunder. Each volunteer is expected to obtain his or her own medical or health insurance coverage.
Photographic Release: I understand and acknowledge that CAC reserves the right to photograph program activities and volunteers for publicity purposes. I hereby give consent for CAC to use my/my child’s photograph and likeness in its publications, including its website and release them from any expectation of liability. I hereby grant and convey unto CAC all right, title and interest in any and all photographic images and video or audio recordings made by CAC.
I agree that these Agreements are intended to be as broad and inclusive as permitted by the laws of the State of Maryland, and that these Agreements shall be governed by and interpreted in accordance with the laws of the State of Maryland. I agree that in the event that any clause or provision of these Agreements shall be held to be invalid by any court of competent jurisdiction, the invalidity of such clause or provision shall not otherwise affect the remaining provisions of these Agreements which shall continue to be enforceable.
I understand and shall comply with all terms and conditions of the Confidentiality Agreement and the Volunteer Waiver and Release of Liability herein, and acknowledge that any violation shall subject me to immediate removal and revocation of future volunteer opportunities for CAC.
I agree that this document and any other documents to be delivered in connection herewith may be electronically signed, and that any electronic signatures appearing on this document are the same as handwritten signatures for the purpose of validity, enforceability, and admissibility.