On-Site Waiver Form

387 Simcoe Street South
Oshawa, ON L1H 4J2

Please read and sign the waiver below prior to your on-site visit at Simcoe Hall.  Thank you.

    Volunteer and Student Placement Hold Harmless Agreement

    I AGREE TO INDEMNIFY AND HOLD HARMLESS Simcoe Hall Settlement House, it agents, employees or volunteers of all liability for loss or damage arising from any cause whatsoever and herby release, waive and discharge Simcoe Hall Settlement House from all liability to my errors executors, administrators, and assigns for all loss or damage and any claims or demands for such loss or damage on account of injury to person or property while participating in and/or being transported to and from the program activities of Simcoe Hall Settlement House.

    Do you agree with and attest to the above statement? YesNo

    Volunteer and Student Placement Confidentiality Policy

    Staff, Student Placement and Volunteers of Simcoe Hall Settlement House may receive confidential information. The protection of our clients /members right to privacy and confidentiality is critical and must be maintained by all Simcoe Hall Settlement House
    Employees, directors, students’ placements and volunteers.

    “Confidential Information” means information, in any form, that is disclosed to a third party outside of Simcoe Hall Settlement House or discussed in a public venue, may cause harm to a client of Simcoe Hall Settlement House itself. Confidential information also includes any personal identifying information such as name, address, telephone number, date of birth or person circumstances.

    If an Employee, Director, Volunteer or Student Placement has any doubt about whether or not certain information is confidential, he/she must obtain direction from a Supervisor or Director.

    Confidential information cannot be disclosed without the written consent of the person it pertains to.

    Do you agree with and attest to the above statement? YesNo




    Signature (use mouse to sign below):