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 (“Manna”) policies and procedures, including, if applicable, Manna’s policies and procedures for the Community Food Rescue network (“CFR”). 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.
I understand that I am not an employee of Manna and will not be compensated for any time spent volunteering, nor am I entitled to rights, privileges, or benefits of an employee of Manna.
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 and property damage, and will require the exercise of reasonable care to avoid injury and/or damage. I further understand that if I am volunteering for Manna as a CFR food runner, I will be using my personal vehicle to transport food between locations, which involves potential risk of personal injury and damage to my vehicle.
With knowledge of the hazards and potential dangers involved, I still wish to volunteer and hereby agree to assume any and all risks of personal injury or property damage, including damage to my personal vehicle, 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. I understand that if I am injured in the course of my participation as a Manna volunteer, I am not covered by Manna’s workers’ compensation coverage.
I hereby release and discharge Manna and any of its directors, officers, employees, contractors, partners, and agents from any and all liability of responsibility for such accident or injury, and I agree that I, and my assignees, heirs, guardians, and legal representatives, will not make a claim or demand against or sue Manna or any of its directors, officers, employees, contractors, partners, and agents for injury or damage resulting from my participation as a Manna volunteer or in any Manna related activity.
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. If I am volunteering for Manna as a CFR food runner, I hereby declare and affirm under the penalties of perjury, that I have not received a citation for a moving violation or driving under the influence or driving while intoxicated in the past three years.
I understand that I may be photographed while volunteering and my signature (electronic or print) authorizes Manna to use my picture in publications, on Manna’s website and through Manna’s social media outlets, in perpetuity.
I understand I am not permitted to take food or other items from the warehouse or any food distribution locations and that if I am observed taking anything I will be asked to return it and may be asked to cease volunteer service.
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.
I hereby certify that I have been provided with and have reviewed Manna’s policies and procedures regarding the safe handling of food, and I agree to comply with all safe handling policies and procedures as directed by Manna staff. If I am volunteering for Manna as a CFR food runner, I hereby certify that I have also been provided with Manna’s policies and procedures regarding the safe transport of food, and I agree to comply with all policies and procedures regarding both the safe handling of and transport of food.
I understand that Manna has the right to dismiss me as a volunteer, at any time, in its sole discretion.
PRINT NAME: _____________________________________________________ (If you are signing the form for your daughter or son.)
Thank you for feeding hope and fighting hunger in Montgomery County! With your help the community is reaching more than 40,000 neighbors a year.
Revised 6/26/2016 3:26 a6/p6 4838-3789-0345.v1