Volunteer Form | Second Harvest

Volunteer Application

Application Date required

PERSONAL INFORMATION

Name (First and Last)

Cell Phone Number

Home Phone Number

Street Address

Address Line 2

City

State & Zip Code

Date of Birth required

Criminal Record

Have you been convicted of a crime in the last 3 years?

Yes

Do you need volunteer hours for court mandated community service?

Yes

If you have been convicted of a crime, please provide the date and explain the charges.

Note: A conviction record will not necessarily exclude you from volunteering. Factors such as age and time of offense, seriousness, and nature of violation and rehabilitation will be considered. Omitting offenses will automatically make you ineligible. Please be honest when completing this form.

EMERGENCY CONTACT

Emergency Contact Name (First and Last)

Relationship to You

Emergency Contact Phone Number

Availability

List the days and times you are available to volunteer.

What date are you able to begin your volunteer service? required

What date are you wanting to end your volunteer service? required

ADDITIONAL INFORMATION

List any restrictions you may have

Please read the following carefully before signing this application:
By submitting this application, I acknowledge that all the information on the Volunteer Application is correct and that I have reviewed and agree to abide by the Second Harvest Food Bank’s guidelines, customer service guidelines, confidentiality statement and all waiver and release of liability terms listed on this form.

Your Signature

I am 18 years of age or older

Yes

Today's Date required

Waiver and Release of Liability:
The Second Harvest Food Bank accepts volunteer placements through various resources. Some assignments involve strenuous and/or physical labor including, but not limited to: lifting and climbing. I acknowledge my receipt of permission to volunteer. I also acknowledge my understanding that my service as a volunteer on or for Second Harvest Food Bank’s properties or as a volunteer at any events held by Second Harvest Food Bank, may expose me to various risks of injury or illness. In consideration of the permission and privilege allowed to me to serve as a volunteer, I agree and understand that I freely assume all risks, hazards and losses which may occur to me in connection with my exercise of the permission and privilege allowed to me by Second Harvest Food Bank, and I agree not to hold Second Harvest Food Bank, agents, employees, or volunteers liable for risk, hazard, injury, illness, property damage and or loss. I understand that this Waiver and Release of Liability extends to and applies to any personal injuries, injurious results, damages, or losses which I may experience and applies to my estate, executor, heirs and assigns, to not sue or initiate any claims or actions against Second Harvest Food Bank, its agents, employees, officers, directors, volunteers, successors, or assigns regarding any risks, hazards, losses, injuries, illnesses or property damage resulting directly or indirectly out of my volunteer activities with Second Harvest Food Bank.

Confidentiality Statement:
I agree that agency/client information is to be considered confidential and the property of Second Harvest Food Bank. I will not disclose, publish or otherwise reveal any information that can be identified as such without written authorization by Second Harvest Food Bank.

Permission to Use Photograph
I give my permission for Second Harvest Food Bank to use my photograph and name in publications, websites, video, brochures or any other promotional material produced by Second Harvest Food Bank or other press releases distributed to the media.

Thank you for making your volunteer inquiry! We will be in touch soon.