Participe como voluntario en El Prom Carlin (Carlin Prom)

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Gracias por su interés en participar como voluntario en El Prom de la Familia Carlin de Nicklaus Children’s Hospital de este año el 9 de junio de 2023 en Hyatt Regency Coral Gables. Complete el siguiente formulario para ser considerado como voluntario.

Volunteer Information

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All volunteers must be age 21 or older
 
Event Release, Waiver and Hold Harmless Agreement*: I have read and agree to the content stated in the Event Release/Waiver/Hold Harmless Agreement.
 
Media Consent:*: By submitting this form, I hereby give my consent and authorization to Nicklaus Children’s Health System, Nicklaus Children’s Hospital, and Nicklaus Children’s Hospital Foundation, including its physicians, authorized technicians, employees, and authorized agents (collectively “NCHS”) to photograph, film, create digital images, video, interview, create sound recordings, or otherwise create media content (“Content”) of me child related to the Carlin Prom event. I understand that such media content may include my face, image, likeness, voice, name and age.
 
Marketing or Media Purposes*: The Content may be used by NCHS for internal and external marketing, public relations, communications, and promotional purposes. Disclosures may be made to national and local reporters, television programs, news agencies, radio stations, internet, and social marketing or media sites. I hereby consent to and specifically authorize NCHS to disclose and use such Content as indicated above and in Media Consent.
 
COVID-19 Prevention Acknowledgment*: By submitting this form, I consent to completing any pre-event and/or on-site COVID-19 health and safety precautions that may be required.
 
Mask Wearing Acknowledgement*: By submitting this form, I consent to wearing a face mask at all times on-site while volunteering at the event.
 
Vaccine Acknowledgement & Proof of Vaccination*: NCHS requires that all community volunteers have completed a Primary Vaccination Series for COVID-19 prior to commencing any volunteer service onsite at any Nicklaus Children’s Hospital location and provide an Acceptable Form of Proof of Vaccination, which will be maintained by the Volunteer Resources department in a secure and confidential electronic database. NCHS does not permit exemptions to vaccination for volunteers, absent extraordinary circumstances as approved by the Chief Medical Officer or NCHS Chief Operating Officer and subject to appropriate additional precautions, which may include providing solely remote volunteer services.

Proof of vaccination (double sided copy) must be emailed to Samantha.Selvin@Nicklaushealth.org prior to July 15th, 2022. Otherwise, you will not receive confirmation of assigned duties.