E-Signature Record 4d267d94-975b-459b-a682-214db5442c45


Summary
  • * Respondent Reviewed and Signed. The respondent reviewed the contents of their submission, provided contact information for verification, and signed the response.
  • * Signatory Verified. Signatory has verified the information submitted when Response was signed.
  • * Record Completed. All E-Signature Record requirements have been completed.
  • * Record Locked. E-Signature Record was automatically locked. The E-Signature Record fulfills all requirements.
  • * Record Sealed. All steps have been completed. E-Signature Record has been cryptographically signed and hashed.
Record Details
Submitted Form
Submitted Form ID
4967704
Submitted Form Version
60
Submitted Response
Response Submitted Datetime
2024-11-11 21:01:11
Record Checksum
e9c757dcfb21f291ad824df55b680af26cd980950dc68be478c1d5763d4c7989
Package Signature Hash
7532524607c90ff2ba3a42e3ac2bd2a8d909694a1edc84577f07e458968392c2
Custodian Signature Hash
4a4d74c635b4f19f9fb9ef7ef848973214540d18738ec460a1242e207844f84d
Events
Date-Time E-Signature Event
2024-11-11 21:01:11 Initialized. E-Signature Record created.
2024-11-11 21:01:11 Started. Respondent started reviewing submitted response.
2024-11-11 21:01:48 Endorsed. E-Signature Record signed by Respondent. The response was locked.
2024-11-11 21:05:02 Completed. E-Signature Record completed.
2024-11-11 21:05:02 Locked. E-Signature Record locked. No additional changes possible.
2024-11-11 21:05:02 Sealed. E-Signature Record sealed. Cryptographic controls generated for E-Signature Record.

Response in E-Signature Record

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Logo

Code of Conduct


I recognize it is a privilege to participate in the Project Healing Waters Fly Fishing (PHWFF) program, and I recognize that my behavior during events is a direct reflection on the reputation of PHWFF and its good name. 
Therefore, I will always conduct myself in a manner that brings credit to PHWFF. I further understand that any behavior of mine that is recognizably unacceptable will not be tolerated, or condoned, by PHWFF.

While engaged in PHWFF activities, I am aware I must always conduct myself in a mature and responsible manner, so as not to bring discredit to PHWFF or any other organization or person. I will comply with instructions as issued by the PHWFF Leader, when on a PHWFF outing, and respect his or her authority during the event.

Failure to observe the provisions of this Code of Personal Conduct may result in termination of my association with PHWFF, without right of appeal.
I agree to the terms mentioned above  
- I will adhere to the policies adopted by the organization and govern my actions accordingly. *
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Code of Ethics



1.   Purpose. The purpose of this policy is to emphasize the principles of moral and ethical behavior to which all associated with Project Healing Water Fly Fishing, Inc. (the "Organization") are to be held for the benefit of the Organization.

2.   Cancellation. This document revises the Code of Ethics Policy of 03-15-13.

3.  Applicability. This policy applies to employees, officers, trustees, consultants, contractors, volunteers or others who hold themselves out to be working for, or in conjunction with, the Organization, including all such personnel affiliated with third parties which have contractual relationships with the Organization (the "PHWFF Representatives").

4.  Ethical Principles of the Organization.

a.  Personal and Professional Integrity. 
The PHWFF Representatives shall act with honesty, integrity and openness in all their dealings as representatives of the Organization and promote a work environment that values respect, fairness and
integrity. All such individuals have obligations to donors to work effectively and responsibly in delivering services to the soldiers and veterans with disabilities (the “Participants”), and to represent accurately our mission, activities and financial status when soliciting donors or submitting government reports.

b.  Obligation to Beneficiaries. 
The Organization has obligations to the Participants and to the public agencies which entrust them to us and provide access to these Participants. The Organization’s obligations to Participants and the agencies
who entrust them to the Organization are to provide the highest quality service we are capable of providing and to do so safely and with respect.

c.  Openness and Disclosure. 
The Organization shall provide accurate and timely information to the public, the media and stakeholders, where reasonable and appropriate.

d.  Confidentiality. 
Respecting the privacy of our Beneficiaries, donors, PHWFF Representatives, and of the Organization itself is a basic value. Personal and financial information is confidential and should not be disclosed or discussed with anyone without proper permission or authorization. Reasonable precautions should be taken against
inadvertent dissemination of confidential information in any form whatsoever, and authorized dissemination of confidential information should follow any reasonable limitations on dissemination imposed by the authorization.

e.  Inclusiveness and Diversity. 
The Organization shall take meaningful steps to promote inclusiveness and diversity in its hiring, retention, promotion, board recruitment and selection of Participants.

f.  Legal Compliance. 
The PHWFF Representatives will be vigilant in compliance with the duly adopted laws, regulations, and applicable policies that govern and regulate our Organization.


g.  Policy Compliance and Enforcement.

(1) Any PHWFF Representative having knowledge of any violation of this policy shall take reasonable actions to report such violation to the Chief Executive Officer (CEO), or his or her designee, and the Board of Trustees (the “Board”) Chair who shall refer the complaint to the Governance Committee of the Board for further investigation and recommendations for action, unless the complaint is determined by the CEO and Board Chair to be frivolous.

(2) The Organization prohibits retaliation against any PHWFF Representative for reports or disclosures made in good faith under the provisions of this ethics policy.

(3) The report may be oral or in writing and shall be made promptly.

(4) Information provided in such a report shall be provided to third parties only if legally required or if necessary for the Organization to carry out a thorough investigation and review.

(5) After its investigation, if any, the Governance Committee shall report its findings and recommendations for action to the Board through the Chair.

(6) The Governance Committee shall establish policies and procedures for its investigations and reports including procedures providing a right to be heard for persons against whom violations of ethics have been reported.

h.  Conflicts of Interest. 
Each individual should ensure that his or her actions are without interests which may be in conflict with the interests of the Organization, or appear to be in such conflict. When such individual has a potential
conflict, he or she shall report it to the CEO and the President, or their designee, and the Organization shall proceed to review such conflict under the process described in the Conflict of Interest Statement adopted by the Organization.

5.  Acknowledgment of Ethical Standards Process.

a. Upon associating with the Organization, and yearly thereafter, all PHWFF volunteers at the Program Level, and above, shall sign the attached Acknowledgement of Ethical Standards Form.

b. Signed and dated forms will be submitted to the immediate-superior-in-charge (e.g., program-level volunteer submits form to Program Lead, Program Lead submits form to Regional

6.  Authority. 
The Board formally adopted this policy at the 15 March 2013 meeting and was revised by Trustees and the CEO on 14 May 2013. 


Acknowledgement of Ethical Standard


I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTAND THE PROJECT
HEALING WATERS FLY FISHING, INC. (THE “ORGANIZATION”) CODE
OF ETHICS POLICY AND AGREE TO ABIDE BY ITS REQUIREMENTS.

I WILL ALWAYS DO MY BEST TO CONDUCT MYSELF IN A MANNER
THAT BRINGS HONOR TO MY SERVICE TO THE ORGANIZATION.

I WILL UPHOLD THE PUBLIC TRUST VESTED IN THE ORGANIZATION
AS A RECOGNIZED CHARITABLE ORGANIZATION AND IN ALL MY
ACTIONS ON ITS BEHALF SHALL MAINTAIN THE CONFIDENTIALITY
OF SENSITIVE INFORMATION INVOLVING THE ORGANIZATION AND
ITS PARTICIPANTS, DONORS, STAFF, AND VOLUNTEERS.

I SHALL TREAT ALL INDIVIDUALS INVOLVED WITH THE
ORGANIZATION WITH RESPECT AND FAIRNESS AND MY CONDUCT
SHALL BE CONSISTENT WITH THE PRINCIPLES OF THE
ORGANIZATION’S CODE OF ETHICS POLICY.

I WILL ADHERE TO THE POLICIES ADOPTED BY THE ORGANIZATION
AND GOVERN MY ACTIONS ACCORDINGLY.

BY AFFIXING MY SIGNATURE BELOW, I AGREE THAT I HAVE READ
AND AGREE TO THE PROVISIONS CONTAINED HEREIN.


I agree to the terms mentioned above  
- I will adhere to the policies adopted by the organization and govern my actions accordingly. *
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Adult Hold Harmless Agreement

RELEASE AGREEMENT

 

In consideration of the privilege granted me to participate in the Project Healing Waters Fly Fishing, Inc. (“PHWFF”) programs (the “Programs”) as hosted by PHWFF and/or local affiliates thereof (collectively with PHWFF, the “Organizations”), I, the undersigned, in acknowledgment that I am doing so entirely upon my own initiative, risk and responsibility, do hereby, for myself, my heirs, executors, and administrators, agree to remise, fully release, hold harmless, and forever discharge the Organizations and each of their officers, directors, employees and volunteers, acting officially or otherwise, jointly and severally (collectively, the “Releasees”) from any and all claims, demands, actions or causes of actions, on account of my death or on account of any injury to me or my property while participating, or as a result of my participation, in the Programs. 

 

I fully understand that injury  may occur from any cause whatsoever, including, without limitation, the inherent risks and dangers involved in fly fishing (particularly while wading or boating), the negligence of any Releasee, the risk of exposure to the novel coronavirus or any evolution thereof (“Covid-19”) or the consumption of alcohol by me or others. The ability to participate in the Programs is of such value to me that I hereby choose to accept the foregoing risks, including serious and potentially life threatening injury or illness, long-term disability, and even death, in order to participate in the Programs. I further understand that any failure by me to comply with the Organizations’ guidelines, procedures, and protocols, in general and with respect to safety guidelines and/or COVID-19 protocols may result in my immediate expulsion from the Programs.

 

MEDICAL CARE:  In the event of injury to me while participating in the Programs, I hereby authorize any of the Releasees to seek on my behalf any necessary medical attention.

 

Covid-19:  I hereby agree, represent, and warrant that I will not participate in the Programs if I (i) experience symptoms of COVID-19, including, without limitation, fever, cough, loss of smell or taste, or shortness of breath, (ii) have a suspected or diagnosed/confirmed case of COVID-19, or (iii) have been exposed to any person who has a suspected or confirmed case of COVID-19. I agree to notify the relevant Program immediately if I believe that any of the foregoing access/use restrictions may apply within 72 hours of my participation in any Program. 

 

In addition, I acknowledge and agree that I understand and will follow each Program’s COVID-19 procedures, and further that the Program may revise its procedures at any time based on updated recommended guidance and protocols issued by the governmental and public health agencies and further agree that I will comply with such revised procedures. I acknowledge and agree that, due to the nature of the Programs, social distancing of 6 feet per person may not always be possible.  I fully understand and appreciate and acknowledge that my participation may, despite the Organizations’ reasonable efforts to mitigate such dangers, result in exposure to COVID-19.

 

COMPLIANCE WITH VA AND VAVS:  I understand that the Programs are being conducted in collaboration with the U.S. Department of Veterans Affairs (the “VA”) and the U.S. Department of Veterans Affairs Voluntary Service (the “VAVS”); or with the Department of Defense (the “DOD”). I agree to abide by, and act in accordance with, all applicable VA and VAVS or DOD rules, regulations or orders and all instructions or directions from the VA, VAVS or DOD and its affiliated agencies or their staff relating to my involvement in the Programs.

 

ASSUMPTION OF RISK AND WAIVER OF LIABILITY: I have read and fully understand the consequences of this Release Agreement, including that I give up my right to bring  any claims against Releasees including for personal injuries, death, disease, quarantine, property losses, or any other loss, and give up any right I may have to seek damages, whether known or unknown, foreseen or unforeseen.  I further attest that I am over 18 years of age and possess the capacity to enter into this Release Agreement.

 

SEVERABILITY:  If any term or other provision of this Release Agreement is determined by a court of competent jurisdiction to be invalid, illegal or incapable of being enforced by any rule of law or public policy, all other terms, provisions and conditions of this Release Agreement shall nevertheless remain in full force and effect.

I have read this Release Agreement and fully understand the consequences of this Release Agreement, including that it releases the Releasees from any and all liability on account of any injury to me or to my property. I further attest that I am over 18 years of age and possess the capacity to enter into this Release Agreement.  
- I have read this Release Agreement and fully understand the consequences of this Release Agreement, including that it releases the Releasees from any and all liability on account of any injury to me or to my property. I further attest that I am over 18 years of age and possess the capacity to enter into this Release Agreement.*
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Media Release

PROJECT HEALING WATERS FLY FISHING INC. [PHWFF] FORM OF CONSENT FOR USE OF PERSONAL INFORMATION                                                                            AND VISUAL IMAGES


PHWFF is a national 501(c)(3) non-profit charitable organization registered with the State of Maryland. Project Healing Waters Fly Fishing, Inc. is dedicated to the physical and emotional rehabilitation of disabled active military service personnel and disabled veterans through fly fishing and associated activities including education and outings.


Consent Form

In consideration of the opportunities and services offered by PHWFF and my participation in
them, I agree to permit PHWFF to use pictures, photographs, and/or other visual images of me, and narrative material about me and my participation in the PHWFF programs, for its educational and promotional efforts and its website. I assign all rights, title and interest in and to the material and the copyright of the materials to PHWFF. 
I waive any right to inspect and approve the photos, or other images and narrative materials about me, and any advertising and promotional copy with which they are connected. I understand that the circulation of such materials could be nationwide and that there will be no compensation to me for the use of such materials by PHWFF.

I waive any claim and all causes of action I may have against the PHWFF for its use of the pictures, photographs or visual images and narrative material.

The rights and protections granted in this document may be exercised by PHWFF at any time without limitation.
My participation in the programs of PHWFF is voluntary and in my private capacity.

Edit this text  
Edit this text  
- I have read this document and intend to be bound by it.
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Your Signature

I have read this Release Agreement and fully understand the consequences of this Release Agreement, including that it releases the Releasees from any and all liability on account of any injury to me or to my property. I further attest that I am over 18 years of age and possess the capacity to enter into this Release Agreement.
signature
Signature
initials
Initials
Allen D. Lung
Name
adl
Initials
2024-11-11 21:01:48
Datetime (UTC)
Signatory
Allen D. Lung (Respondent)
allendlung@gmail.com
209.177.114.7
42810c8b-7926-480a-8335-7fd07ad7099e