(Note: Ancilla Domini Sisters, Inc. is the legal title for the Poor Handmaids of Jesus Christ)

WAIVER AND RELEASE OF ALL CLAIMS

I hold harmless, waive and release all claims, losses or damages, including negligence against, the Ancilla Domini Sisters, Inc., of bodily injury, including death, personal injury and property damage, and I agree to hold harmless, waive and release the Ancilla Domini Sisters, Inc. and its officers, directors, agents, representatives for losses, claims, causes of actions, as a result of or arising out of my volunteering at their Motherhouse and its entities. I am aware the Ancilla Domini Sisters, Inc. is a non-profit organization and will not provide health and accident coverage for myself and it is my sole responsibility for any medical bills, co-payments or prescriptions arising out of injuries or stress related injuries sustained while volunteering for this project. It is acknowledged and acceptable to me that as a volunteer, wages, and employee benefits, are waived.

I further release Ancilla Domini Sisters, Inc. and its officers, directors, agents, representatives, other volunteers and employees from any claim whatsoever and on account of first aid, treatment or services rendered me while waiting for ambulance or medical treatment from professional medical personnel.

I have read and fully understand this Waiver and Release of Claim form: