If you are NOT 18 years of age or older, your parent or legal guardian MUST read & sign the agreement.
LAST NAME________________________________ FIRST NAME ____________________________________
CITY____________________________________________ STATE________ ZIP_______________
TELEPHONE __________________________ Circle one: Home Work Cell
AGE (check one) Under 18 _____ (parent or legal guardian MUST sign the form) OR 18+ _____
EMERGENCY CONTACT NAME _________________________________________________________________
RELATIONSHIP________________________________ PHONE___________________________ H W C
I_______________________________________, certify that I agree to comply with all Manna Food Center policies and procedures. I affirm that I have no financial interest or affiliation with any organization which may have interests that conflict with, or appear to conflict with, the best interests of Manna Food Center.
I understand that I am not an employee of Manna Food Center.
I also understand that Manna expects each volunteer to honor the confidentiality of information learned during the normal course of working with clients or partner organizations, including the names, addresses, and other information about clients.
I understand that the activities which are typically performed by Manna volunteers, and which may be performed by me as a Manna volunteer may involve physical activity, contact with unidentified and unfamiliar persons, travel to and from various unspecified locations and other potential risks of injury. Knowing this, I still wish to volunteer and hereby assume the risk, with respect to any liability of Manna for such risks, of any accident or injury to person or property that I may sustain in connection with my participation as a Manna volunteer or in any Manna related activity.
In addition, I hereby release and discharge Manna and any of its directors, officers and employees from any and all liability of responsibility for such accident or injury.
I hereby declare and affirm under the penalties of perjury, that I have never been convicted of a violent crime, child abuse, child pornography, child abduction, kidnapping, rape or any sexual offense. Further, I will not engage in any inappropriate, violent, or offensive behavior while volunteering with Manna Food Center.
I understand that I may be photographed while volunteering and my signature below authorizes Manna Food Center to use my picture in publications, on Manna’s website and through Manna Food Center’s social media outlets, in perpetuity.
I understand I am not permitted to take food or other items from the warehouse and that if I am observed taking anything I will be asked to return it and may be asked to leave the center.
I understand that no smoking is permitted anywhere on Manna premises, including both the main and supplemental and distribution or program locations, Manna truck or van.
PRINT NAME: _____________________________________________________ (If you are signing the form for your daughter or son.)
Thank you for feeding hope and fighting hunger in Montgomery County!