Volunteer form

PERSONAL INFORMATION

Are you 16 or older?
Have you been convicted of a crime in the last 3 years?

EMERGENCY CONTACT

VOLUNTEER EXPERIENCE

Have you volunteered before?

AVAILABILITY

What Days and Time of the Day are You Available?

ADDITIONAL INFORMATION

REFERENCES (Professional, not Personal)

REFERENCE 1

REFERENCE 2

REFERENCE 3

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

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, damage or losses which I may estate, executor, heirs and assigns not to sue or initiate any claim procedure against Second Harvest Food Bank, its agents, employees, volunteers, assigns, or successors with respect to any risk, hazard, loss, injury , illness, or property damage I may experience or sustain arising directly or indirectly out of my volunteer activities with or at the 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.

20 N Murray St.

Springield, OH 45503

T 937.325.8715

F 937.325.6240

E info@theshfb.org

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