A Child Like Mine Policies
Consent for Use and Disclosure of Confidential Information
A Child Like Mine is a nonprofit grant-making organization whose mission is to support the autism community and their families. We provide services and equipment for in-home use and support within the community. You privacy and personal information security is very important to us. Whenever you provide information about yourself or your family to A Child Like Mine, you hereby consent to allow A Child Like Mine to view and use the information that you share with us, including but not limited to any confidential information such as financial information or health care information. By acknowledging this Privacy Policy where indicated in the application, you understand and agree that A Child Like Mine will share that information with our directors, officers, employees, volunteers and attorneys as needed to take action on your application; however, we do not share this information with anyone in our organization, however, who does not need it in order to process your application. If your application is approved, we may also need to share some portion of your information with third persons in order to fulfill the grant, but we do not share this information with anyone who does not need the information in order to take action to fulfill the grant. We will not sell or share your information to any third person so that they can independently market their own products or services to you. We may share your information with governmental agencies, regulatory bodies and law enforcement agencies to the extent necessary to comply with applicable laws or valid legal processes. We may retain your information in our files for internal record-keeping purposes, but we make no commitment to retain or store this information for any purpose whatsoever. Although A Child Like Mine will use reasonable efforts to protect this information from disclosure to unauthorized persons, A Child Like Mine will not be held responsible for unauthorized access by third persons, theft or criminal behavior by third persons or accidental release of this information. By acknowledging this Privacy Policy where indicated in the application, you are granting permission to A Child Like Mine to call your home or other alternative number and leave a message containing confidential information on a voicemail or in person, may mail or email you in reference to any items that assist the Organization in carrying out requests for service, payments or any items pertaining to your application for support or the fulfillment of any grant or support provided by the Organization, including follow up to your clinical care. By sharing information with A Child Like Mine and by acknowledging this Privacy Policy where indicated in the application, you hereby consent to be bound to the terms of this Privacy Policy. A Child Like Mine may make changes to this Privacy Policy at any time by posting those changes to its website. Any such changes will become effective as soon as they are posted to the website.
Release and Waiver of Liability
This Release and Waiver of Liability (the “Release”) is executed as of the application date by the applicant (the “Grant Recipient”) or the parent or legal guardian of the Grant Recipient, in favor of A Child Like Mine, a Georgia nonprofit corporation and its directors, officers, employees, and agents. The Grant Recipient has applied for a grant from A Child Like Mine to engage in activities funded through an award by A Child Like Mine (the “Activities”). The Grant Recipient understands that the Activities may include physical activities, exposure to hazardous conditions and other circumstances that may result in personal injuries. The Grant Recipient hereby freely, voluntarily and without duress Releases A Child Like Mine under the following terms: Release and Waiver. By acknowledging this Release and Waiver where indicated in the application, Grant Recipient does hereby release and forever discharge and hold harmless A Child Lile Mine and its successors and assigns from any and all liability, claims, and demands of whatever kind or nature, either in law or in equity, that arise or may hereafter arise from Grant Recipient’s Activities with a vendor or service provider funded through a grant by A Child Like Mine. GRANT RECIPIENT UNDERSTANDS THAT THIS RELEASE DISCHARGES A CHILD LIKE MINE FROM ANY LIABILITY OR CLAIM THAT THE GRANT RECIPIENT MAY HAVE AGAINST A CHILD LIKE MINE WITH RESPECT TO ANY BODILY INJURY, PERSONAL INJURY, ILLNESS, DEATH, OR PROPERTY DAMAGE THAT MAY RESULT FROM GRANT RECIPIENT’S ACTIVITIES FUNDED THROUGH A GRANT BY A CHILD LIKE MINE, WHETHER CAUSED BY THE NEGLIGENCE OR WILLFUL CONDUCT OF A CHILD LIKE MINE OR ITS OFFICERS, DIRECTORS, EMPLOYEES, OR AGENTS OR OTHERWISE. GRANT RECIPIENT ALSO UNDERSTANDS THAT A CHILD LIKE MINE DOES NOT ASSUME ANY 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. Medical Treatment. By acknowledging this Release and Waiver where indicated in the application, Grant Recipient does hereby release and forever discharge A Child Like Mine from any claim whatsoever which arises or may hereafter arise on account of any first aid, treatment, or service rendered in connection with the Grant Recipient’s Activities funded by a grant from A Child Like Mine. Assumption of the Risk. Grant Recipient understands that the Activities may involve work that may be hazardous to the Grant Recipient, including, but not limited to, physical activities, exposure to hazardous conditions, or other circumstances that may result in personal injuries, and transportation to and from the Activities’ sites. By acknowledging this Release and Waiver where indicated in the application, Grant Recipient hereby expressly and specifically assumes the risk of injury or harm in the Activities and releases A Child Like Mine from all liability for injury, illness, death or
property damage resulting from the Activities. Insurance. Grant Recipient understands that A Child Like Mine does not carry or maintain health, medical, or disability insurance coverage for any grant recipient. Each Grant Recipient is expected and encouraged to obtain his or her own medical or health insurance coverage. Governing Law; Validity. By acknowledging this Release and Waiver where indicated in the application, Grant Recipient expressly agrees that this Release is entitled to be as broad and inclusive as permitted by the laws of Georgia and that this Release shall be governed by and interpreted in accordance with the laws of Georgia. Grant Recipient also agrees that in the event that any clause or provision of this Release 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 this Release, which shall continue to be enforceable. Grant Recipient Under 18. If the Grant Recipient is younger than 18 years old, then the person acknowledging this Release and Waiver where indicated in the application hereby certifies that he or she is the parent or legal guardian of the Grant Recipient and does hereby give this Release and Waiver without reservation on behalf of the Applicant.
Publicity and Photo Release Form
By acknowledging this Publicity and Photo Release where indicated in the application, I hereby grant to A Child Like Mine the absolute and irrevocable right and unrestricted permission to use the name, likeness, image, voice, and/or appearance of the Applicant as such may be embodied in any photos, video recordings, audiotapes, digital images, and the like, taken or made on behalf of A Child Like Mine or its partners and affiliates. I agree that A Child Like Mine has complete ownership of such material and can use said material for any purpose consistent with the mission of A Child Like Mine. These uses include, but are not limited to, videos, publications, advertisements, news releases, websites, and any promotional or educational materials in any medium. I acknowledge that the Applicant will not receive any
compensation for the use of such images, video, likeness, etc. By acknowledging this Publicity and Photo Release where indicated in the application, I hereby release and discharge A Child Like Mine, and its agents, representatives and assigns, from any and all claims and demands arising out of or in connection with the use of the Applicant’s name, likeness, image, voice and/or appearance, including any and all claims for invasion of privacy, right of publicity, misappropriation or misuse of image and/or defamation. By acknowledging this Publicity and Photo Release where indicated in the application, I represent that I am at least 18 years old and that I have read the foregoing and fully understand its contents. If the Applicant is younger than 18 years old, then I hereby certify that I am the parent or legal guardian of the Applicant and do hereby give my consent without reservation to the foregoing on behalf of the Applicant. By acknowledging this Publicity and Photo Release where indicated in the application, I agree that this release shall be binding upon me and my heirs, legal representatives and assigns (and in the case of an Applicant that is younger than 18 years old, upon the Applicant and his heirs, legal representatives and assigns). This agreement is made and entered into under the laws of Georgia and shall be governed and interpreted in accordance with the laws of Georgia. This agreement embodies the entire agreement of the parties. No modification of this agreement shall be of any effect unless it is made in writing and signed by all of the parties to the agreement.