Dentistry From The Heart

Dentistry from the Heart – Volunteer Registration/Release Form

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If you are your interested in hosting your own DFTH event please check the box below and someone from our office will follow up with you shortly regarding your inquiry.

Volunteer Contact Information

As a volunteer at the above designated Dentistry from the Heart (“DFTH”) Event, I agree to follow the directions of designated practice managers in my efforts offered in support of this free dentistry public service. Furthermore, I agree to indemnify, defend and hold harmless the above practice, its officers, and the Dentistry from the Heart organization for any injuries or other difficulties encountered in the execution of my duties.

This Release and Waiver of Liability is executed on by the above mentioned. This volunteer releases Dentistry from the Heart, a nonprofit organization, the above dental practice, and all associated officers of said organizations from liability pertaining to the free dentistry event to be undertaken.

Said Practice and Charity also enjoy the coverage of Sovereign Immunity extended to both parties by the Dental Association of the parties’ respective states.

No activities are to be undertaken without the express permission of said practice and without proper license for technical undertakings pertaining to treatment offered.


By becoming either a Basic or Full Provider Support member of DFTH, DFTH hereby grants to you, one dental practice, a limited, non-exclusive, non sub-licensable license to use those items listed on the DFTH website as included in membership (such as, but not limited to, DFTH trademarks, DVD commercials, press kits, and anything else provided by DFTH to you, etc. (herein after the “DFTH Property”). This license permits you to use the DFTH Property in connection with one dental practice only, and only for the designated number of events permitted for your membership level.

You acknowledge DFTH's exclusive rights in the DFTH Property and, further, acknowledge that the DFTH Property is unique and original to DFTH and that DFTH is the owner thereof. You shall not, at any time during or after the effective Term of your membership dispute or contest, directly or indirectly, DFTH's exclusive right and title to the DFTH Property or the validity thereof in whole or in part.


LICENSEE recognizes the value of the goodwill associated with the DFTH Property, in particular its trademarks, and acknowledges that the DFTH trademarks and all rights therein, including the goodwill pertaining thereto, belong exclusively to DFTH.


DFTH shall have the right, at all reasonable times, to inspect volunteer’s services and promotional activities employing the DFTH trademarks to ensure that such use is of property quality and otherwise consistent with this Agreement.


The term of this license agreement coincides with the term of your active membership, paid in full. Should your membership lapse for any reason, the license granted hereunder terminates. Upon termination, you understand you must cease immediately using any DFTH Property. You may not hold any events using DFTH Property or advertising materials, nor may you use trademarks or logos that are confusingly similar with DFTH trademarks. You shall be responsible to pay all costs, damages, and attorneys’ fees necessary for DFTH to enforce this Agreement. If the quality of the DFTH trademark is not satisfactory as used by the volunteer, the volunteer will be provided thirty (30) days to correct any deficiencies. If the deficiencies are not corrected, DFTH may terminate this license agreement for cause in which volunteer is not owed any refund.


Nothing contained herein shall be construed as creating any agency, employment relationship, partnership, principal-agent or other form of joint enterprise between the parties.

GOVERNING LAW. This Agreement shall be governed by and interpreted in accordance with the laws of the State of Florida. Any action to enforce the terms of this Agreement must be brought in the State courts located in Pasco County, Florida or the United States District Court for the Middle District of Flroida. All parties consent to personal jurisdiction in the State of Florida.

IRS 501 (C) (3) Dentistry from the Heart –
Public Charity Status Per: 170 (b) (1) (A) (VI)
Taxpayer Identification Number: 20-5178003

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