By signing below, I, the undersigned volunteer, agree to provide services to SKC Clinic as a volunteer. As a condition of volunteering, I agree as follows:

For All Volunteers

1. I am donating my services (“SKC Clinic Services”) and I am not entitled to any present or future salary, wages, or other benefits for providing SKC Clinic Services.

2. I understand that the City of Seattle provides limited reimbursement for an injury to a volunteer while providing volunteer services for the City and that the coverage is secondary to any other insurance I may have.

3. I understand that the City of Seattle will appear and defend a claim or lawsuit against me if the claim or lawsuit arises from my volunteer activities, as authorized and limited by Seattle Municipal Code 4.64.100 and .110, except as limited below for professional services provided by clinical providers.

4. I understand I may be exposed to blood, bodily fluids and other potentially infectious materials that may contribute to the risk of acquiring HIV, Hepatitis B, COVID-19 or other diseases. If I am exposed, or if there is a circumstance where I am the source of an exposure, I will immediately report the incident to SKC Clinic officials. I understand if I am exposed, SKC Clinic will provide any relevant onsite test(s) at no cost to me and I agree to be tested if I am the source of an exposure. It is further understood that I am responsible for the cost of all subsequent tests, treatments and medical care.

5. I knowingly assume the risk of participating as a volunteer for SKC Clinic. In consideration of participating as a volunteer for the SKC Clinic, I, for myself, my spouse, my legal representatives, heirs, and assigns, hereby forever unconditionally waive all claims (in law, equity, or otherwise) against SKC Clinic, The City of Seattle, Seattle Center Foundation, and their respective subsidiaries, affiliates, partners, officers, trustees, officials, employees, and agents, and volunteers, (collectively, "SKC Clinic Parties"), arising out of my participation in the SKC Clinic and my provision of SKC Clinic Services. This Agreement does not constitute a waiver of benefits or burdens that may be applicable under the Washington Industrial Insurance Act (RCW Title 51).

6. I also grant SKC Clinic, City of Seattle/Seattle Center, Seattle Center Foundation and their respective agents the right to use, without payment or consideration of any kind, my picture, voice, and other reproductions of my physical likeness in connection with advertising or publicizing SKC Clinic services and activities in all forms of media in perpetuity.

7. I agree to notify SKC Clinic officials immediately if I am injured or if I become aware of any accident or injury to another volunteer or clinic participant.

8. I understand that SKC Clinic officials maintain the right to revoke my participation at any time with or without cause.

9. Volunteer positions may require a Washington State Patrol background check to volunteer for SKC Clinic Services. I will either agree to the background check or I may decline to volunteer.

For All Volunteers Accessing Confidential Information

In compliance with the federal and state privacy laws, I agree to hold in confidence all personal and protected health information I may overhear or come in contact with during and following the performance of SKC Clinic Services. I further agree not to access, or remove from the premises, personal and protected health information or records unless relating to my performance of SKC Clinic Services. It is understood that I shall be responsible for any direct or consequential damages resulting from my violation of this requirement.

As a condition of and in consideration of my use, access, and/or disclosure of confidential information, I understand and agree to the confidentiality requirements outlined in this Agreement. I understand that these requirements and my responsibility to protect the confidentiality and security of information apply when I am off-site as well as at any clinic sites.

Confidential information may include, but is not limited to:

• Patient information (health records, conversations, demographic information, contact information).

• Volunteer information (contact information, license information).

• Proprietary information (financial reports, production reports, strategic plans, contracts, communications, computer programs, technology).

• Third party information (computer programs, vendor information, technology).

I will access, use and disclose minimum confidential information only as necessary to perform my role.

This means, among other things, that:

A. I will only access, use, and disclose the minimum confidential information as authorized to do this role;

B. I will not in any way access, use, divulge, copy, release, sell, loan, review, alter, or destroy any confidential information except as properly and clearly authorized within the scope of my role and in accordance with all applicable laws;

C. I will report to my shift supervisor or lead any individual’s or entity’s activities that I suspect may compromise confidential information.

Because all of my passwords (and/or other authentication devices such as tokens or cards) are the equivalent of my signature and because I am the only person authorized to use them, I agree to the following:

A. I will safeguard and not disclose my passwords or allow the use of my authentication devices by anyone including my manager or supervisor or another volunteer or staff member.

B. I will not request access to or use any other person’s passwords or authentication devices.

C. I accept responsibility to log out of the system to which I’m logged on. I will not under any circumstances leave unattended a computer to which I have logged on without first either locking it or logging off the workstation.

D. If I have reason to believe that the confidentiality of my password has been compromised, I will immediately notify my supervisor.

E. I understand that my password/or access will be deactivated in the event my role no longer requires use of the computerized system.

F. I understand that SKC Clinic has the right to conduct and maintain an audit trail of all access to patient and volunteer information and other system activity such as internet access and SKC Clinic may conduct a review to monitor appropriate use of my system activity at any time and without notice.

G. I understand and accept that I have no individual rights to or ownership interests in any confidential information referred to in this agreement and that therefore SKC Clinic may at any time revoke my passwords or access codes.

I understand that it is my responsibility to be aware of these policies specifically addressing the handling of confidential information and that misconduct may result in loss of volunteer privileges.

I understand my obligations under this Agreement will continue indefinitely after leaving my role with SKC Clinic.

Special Provisions Applicable to Clinical Providers

If I am a clinical provider, I also agree as follows:

A. I represent that I have all active licenses issued by the appropriate licensing authority which are required in order to provide treatment to patients and that I am not currently subject to any disciplinary action or investigation for criminal or professional misconduct in any jurisdiction.

B. I shall inform SKC Clinic officials if my license or disciplinary status changes.

C. I am responsible for performing the SKC Clinic Services in a professional manner and in accordance with the standard of care and all applicable laws, rules, and regulations, including, without limitation, receiving a Hepatitis B vaccine.

D. If I am licensed in a United States jurisdiction other than Washington State, I agree to submit an attestation to the Washington State Department of Health at least ten (10) working days in advance of volunteering in Washington State.

E. I am responsible for the standard of care and quality of treatment I provide patients, and I am not subject to the supervision or control of the City of Seattle or the other SKC Clinic Parties (as defined in 5 above). As a result, I agree that while I am donating my services to the SKC Clinic, I will not be considered a volunteer under the direction of the City of Seattle or the SKC Clinic Parties, and I agree that the provisions of Seattle Municipal Code 4.64.100 and .110 do not and shall not apply. I agree to defend, indemnify and hold the SKC Clinic Parties (as defined above) harmless from all liability, claims, demands, losses, damages, action or judgments of every kind (including reasonable attorney’s fees) which may occur arising out of my treatment of patients and participation in the SKC Clinic.

F. I agree to maintain a professional liability policy relative to my performance of SKC Clinic Services in effect throughout the SKC Clinic. I further agree to inform SKC Clinic of the insurance carrier and policy number with whom I have the professional liability policy. I grant SKC Clinic, City of Seattle, Seattle Center Foundation and their respective agents the right to submit any claims arising out of my performance of SKC Clinic Services to the appropriate professional liability carrier for further handling pursuant to the terms of my policy.

G. Any follow up treatment provided by me to a patient at a different location or after the SKC Clinic dates is outside the scope of SKC Clinic Services.

H. My acceptance of this agreement signifies that I give permission to SKC Clinic to verify the status of my license, my insurance, and my background.

Provision Applicable to All Volunteers