2023 APPROVED Under 18 Volunteer Waiver (BI)

I hereby certify that I am the adult parent or guardian of ___________________________________,
Nina Oicata Prieto

who is a minor child under the age of eighteen (18) years. I hereby agree to accept on my child’s
behalf, a position as a volunteer for Food Banks Mississauga.
In so doing, on my/our own behalf and on behalf of my/our heirs, executors, estate trustees with
or without a Will, administrators, next of kin, successors and assigns, I execute this Release in
favour of FBM, all its directors, officers, employees, agents, servants, contractors, elected, and
appointed officials, sanctioning bodies, all persons for whom it is responsible at law and its
successors and assigns in consideration of the voluntary participation in FBM events.
At all times, the privacy and dignity of clients, donors, volunteers and staff will be respected and
the mission, vision and values of FBM will be followed in accordance with FBM policies,
standards, and guidelines.
Collection of Personal Information

I consent to FBM collecting and using my child’s information, including but not limited to name,
address, telephone number, email address, age, medical information (if I require medical
accommodations in my volunteer role or activities), and other information which can identify my
child. I understand that FBM requires this information in order to open and maintain an active
volunteer file for my child.
I understand FBM will not use this information other than communicating to me/my child
regarding my child’s volunteering or support of FBM and in administering the volunteering
relationship.
Confidentiality
I agree to hold strictly confidential any information my child obtains in the performance of their
volunteer duties relating to clients, donors, agencies, workplace accounts, and any other
information about FBM that is identified as confidential. Sharing information between
volunteers and staff will be done on a need to know basis in order for staff and volunteers to
fulfill their responsibilities.
Information relating to clients, donors, workplace accounts, and agencies shall not be related to
any individual or agency outside of FBM unless explicitly requested by FBM staff.
When in doubt as to the confidentiality of certain information, no disclosure should occur
without confirming with FBM staff that such disclosure has been authorized.
Photography
I grant FBM permission to use any photographs or videotape images of my child taken in the
course of my involvement, and to use my child’s name, image, comment(s) and information
regarding their volunteer role, activities, affiliation and city of residence for FBM’s purposes in
any media and territory in perpetuity.
Medical Treatment
In the event of injury or illness while I am under the supervision of FBM, I consent (if I am
unable to provide consent or deny consent myself at the time that a decision must be made)
to receive, or to have my child or ward who is under the supervision of FBM receive, first aid
and/or any further medical attention that potentially may be required to the extent determined
by, and at the discretion of FBM staff, emergency medical services, and licensed medical
professionals.
Liability
I waive and release any and all claims for myself, my child, my heirs, executors and
administrators against FBM and any other sponsor or organization involved, from any and all
claims or liability for death, personal injury or property damage of any kind however caused,
including any claim or liability arising from the negligence of the FBM, its agents, servants, or
employees and of any person on site, arising out of, or in the course of, my participation as a
volunteer for which I choose to participate. This Release of Waiver extends to all claims,
foreseen or unforeseen, known or unknown.
I declare that I am at least 18 years of age and all the information provided on this application
form and in any other accompanying documents is complete and true in every respect.
I agree that this Release shall be governed by the laws of Ontario.
I agree that if any portion of this Release is held 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 in full legal force and effect.
I agree that this document constitutes the entire agreement between me and FBM relating to
its subject matter and that no oral representations have been made which would in any way
affect or detract from the enforceability of this Release on its terms as written.
____________________________________
Karin Dayana Prieto Valencia ____________________________________
Parent/Guardian Name Parent/Guardian Signature
_______________________
June 29 2024
Date

2023 APPROVED Under 18 Volunteer Waiver (BI)

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2023 APPROVED Under 18 Volunteer Waiver (BI)

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I hereby certify that I am the adult parent or guardian of ___________________________________,

Nina Oicata Prieto

Collection of Personal Information

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