Individual Volunteer Intake Form Page 2
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1
2Family Information
If additional family members are volunteering today, you must fill out the following. Please provide last name if
different from your own.
Name:_____________________________________
Birthdate: _________*
Relationship:_____________________
Name:_____________________________________
Birthdate: _________*
Relationship:_____________________
Name:_____________________________________
Birthdate: _________*
Relationship:_____________________
Name:_____________________________________
Birthdate: _________*
Relationship:_____________________
Name:_____________________________________
Birthdate: _________*
Relationship:_____________________
Name:_____________________________________
Birthdate: _________*
Relationship:_____________________
All
m ust
*
adults 18 & older
sign the consent waiver & release of liability agreement below.
Interests/Qualifications
Volunteer Agreement
In signing this liability waiver, I certify that I am a willing participant in the Community FoodBank of New
Jersey volunteer program. I agree to work according to instructions I receive. I agree to behave in a
responsible manner. I agree to perform only work that I feel comfortable in doing and that I feel I can
accomplish safely. I agree I am wearing clothes and shoes that I believe will provide protection according to
the work conditions.
Permission – Use of Photographs
I grant permission to use individual and group volunteer photographs, films and videos of me child for
promotional or other uses furthering the mission of the Community FoodBank of New Jersey, including use on
the CFBNJ website.
Acknowledgement and Assumption of Risk
I recognize that the opportunity to participate in the Community FoodBank of New Jersey volunteer program
may involve physical labor and may carry a risk of personal injury and I hereby agree to assume all risks which
may be associated with my participation. I hereby release, discharge, waive and relinquish all claims, liabilities
and damages I may sustain from bodily injury, personal injury or property damage and hold harmless the
Community FoodBank, its officers, directors, employees and agents.
Consent
I have read this form and fully understand that by signing this form I am giving up legal rights and/or
remedies which may otherwise be available to me regarding any losses I may sustain as a result of my
participation.
Signature:
Date:
Parental Consent (
required of all volunteers 17 years of age or younger
)
I, the undersigned, as the parent or legal guardian of the child/children named herein, do hereby agree to the
above consent, waiver and release of liability agreement above and allow my child/children to participate as a
volunteer for the Community FoodBank of New Jersey.
Signature of Parent or Guardian:__________________________________ Date:_________
Opportunities for volunteers are provided without regard to race, religion, national origin, gender, age or disability.
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