NW COMMUNITY FOOD LIABILITY WAIVER

NW Community Food (NWCF) is a nonprofit organization whose mission is to alleviate food insecurity and poverty by distributing food and cleaning supplies to low-income neighbors. NWCF is committed to doing all it can to have a healthy and safe environment for our volunteers. All NWCF volunteers are required to fill out this form to waive liability. 

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Email *
What is your name?  *
What is your preferred phone number?  *
What is the name and phone number for an emergency contact person in case you can't call them yourself?  *
RISKS: Do you understand that when volunteering in a food pantry environment, certain hazards might be present, such as slippery floors, infection, and exposure to hot or cold weather?  *
Required
MEDICAL TREATMENT: If there's an emergency, I give permission to NWCF to provide first aid and/or to secure necessary treatment by skilled medical personnel.  *
Required
PHOTOGRAPHIC RELEASE. Our pantry sometimes needs photos of volunteers for our website, outreach, and fundraising. 

Do you give consent for NWCF to use your photograph in connection with your volunteer participation for NWCF publications, advertising, publicity, internet pages or social media? 
 *
Required
WAIVE LIABILITY AND HOLD HARMLESS: I release and hold harmless NW Community Food (NWCF), its Board Members, and volunteers, in addition to the University of the District of Columbia (UDC) and its Board Members and staff, from any liability or claim against NWCF and UDC with respect to any injuries, damages, or losses sustained while participating in volunteer activities for NWCF.

I also understand that NWCF and UDC do not assume any obligation to provide financial assistance or other assistance in the event of injury, illness, death or property damage due to my volunteer work.

I also agree that I am responsible for my own protection and comfort while volunteering.

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Required
Please add your initials below to indicate your agreement to waiving liability and holding NWCF and UDC harmless.
*
Do you plan to do any driving for the pantry's mission, such as picking up food or supplies or delivering food?  *
Are you a licensed driver? 
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Are you a licensed driver in: 
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Please provide your driver license number below. 
Do you agree that NW Community Food pantry will not be financially liable for any injuries or property damage that happen while you're driving as part of volunteering for the pantry? 
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Please add your initials below to indicate that you agree that the pantry is not liable for auto-related injuries or property damage. Thanks - our liability insurer requires this. 
Our pantry insurer requires that all volunteer drivers for the pantry have auto insurance for their vehicles used for pantry work. 

What is the name of your current auto insurer? 
Please write your current auto insurance policy number below.  NOTE: If you decide not to renew your auto insurance, please let us know and stop driving for the pantry. 


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