Volunteer

Do you have an interest in volunteering for a specific Foundation event?:*:

Consent for Photography, Video/Television, Audio/Sound Recordings and Interviews*:

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/my child related to the event identified above or treatment of my/my child’s medical condition(s), including any operative or special procedures performed, for the purposes indicated in this consent.

I understand that such media content may include my/my child’s face, image, likeness, voice, name, age, any and all information regarding my/my child’s medical condition(s), treatment, status, prognosis, and other protected health information as defined by the Health Insurance Portability and Accountability Act (HIPAA) as amended, and other federal or state privacy laws. I hereby consent to and specifically authorize NCHS to disclose and use such Content as indicated:

Hold Harmless Agreement:

This is to certify that I release and discharge Nicklaus Children's Health System, Nicklaus Children’s Hospital Foundation, its subsidiaries, employees, agents, directors, officers, affiliated entities and other representatives (“Nicklaus Children’s”), of and from any and all claims, demands, rights and causes of action of whatever kind and nature, arising from and by reason of any and all known and unknown, foreseen and unforeseen causes of action that may be sustained by myself or my son/daughter, as a consequence of mine or my son/daughter’s participation in the Nicklaus Children’s Hospital Foundation events. As a further and additional consideration for such, we agree to indemnify Nicklaus Children's Health System against loss from any and all further claims, demands and actions at law or in equity that may hereafter at any time be made or brought by us or anyone on our behalf for the purpose of enforcing a further claim for damages on account of mine or my son/daughter’s participation in the Nicklaus Children’s Hospital Foundation events. This Hold Harmless will remain valid until and unless we cancel it in writing.

Non-Disclosure Agreement: This Nondisclosure Agreement (the “Agreement”) is made on behalf of Nicklaus Children's Hospital Foundation (the “Owner”), a subsidiary of Nicklaus Children’s Health System, by you (the “Recipient”) as of the date listed below (the “Effective Date”).In consideration of the receipt of the confidential information, the Recipient agrees as follows:

Definition of Confidential Information:

“Confidential Information” means all oral, written and electronic information furnished by the Owner to the Recipient furnished before, on or after the Effective Date. All notes, memoranda, analyses, compilations, budgets, and other documents, whether prepared by Owner, Recipient or others, to the extent they contain or otherwise reflect information about the Owner will also be “Confidential Information.” Confidential Information does not include information which (i) becomes generally available to the public other than as a result of disclosure by Recipient in violation of the terms thereof, (ii) was known by the Recipient at the time of disclosure of the information by the Owner, (iii) was or becomes available to the Recipient from a source other than the Owner if, to the best of Recipient’s knowledge, that source was not legally bound to the Owner to maintain the confidentiality of the information, or (iv) is independently developed by Recipient without reference to the Confidential Information.

Obligation of Confidentiality:

Recipient agrees to keep the Confidential Information confidential, and will not, without prior written consent of Owner. Recipient agrees to notify the Owner in writing of any misuse or misappropriation of such Confidential Information which may come to his/her attention.

Compliance with the Law:

If Recipient becomes legally compelled (by interrogatories, requests for information or documents, subpoenas, civil investigative demands, applicable regulations or similar processes) to disclose any Confidential Information, Recipient agrees to provide Owner with prompt notice of that request(s) so that Owner may seek an appropriate protective order or other appropriate remedy and/or waive Recipient’s compliance with the provisions of this Agreement. If that protective order or other remedy is not obtained by the date that the Recipient must comply with the request, or if Owner waives compliance with the provisions of this Agreement, Recipient agrees to furnish only that portion of the Confidential Information which is legally required in the reasonable opinion of its counsel (after consultation with Owner’s counsel), and to exercise commercially reasonable efforts to obtain a protective order or other reliable assurance that confidential treatment will be accorded to that portion of the Confidential Information which is being furnished or disclosed.

Return of Materials:

Upon termination of services to the Owner, the Recipient will promptly upon the written request of Owner, deliver to Owner all documents or other materials furnished by the Owner to Recipient Constituting Confidential Information, without retaining any copies of them. Recipient will then destroy all other documents or matters constituting Confidential Information (including all electronic images of Confidential Information), and will confirm in writing that all Confidential Information has been returned or destroyed. The obligations of confidentiality and agreements contained in this Agreement will survive any return or destruction of material.

Term of Agreement:

This Agreement will be effective for the time period from the Effective Date to one (1) year after the termination date of the business relationship between the parties. All obligations regarding confidentiality will cease after the Term.

Governing Law and Jurisdiction:

This Agreement will be interpreted in accordance with the internal laws of the State of Florida, without giving effect to the principles of conflicts of law. The parties agree that to the extent either party institutes any legal action, suit or proceeding against the other, arising under or relating to this Agreement, it shall do so in the federal courts in the Southern District of Florida or the state courts located in Miami-Dade County, Florida, and that the party against whom the action is instituted agrees to waive any objection to the laying of such suit, action or proceeding in such courts.