Ruth's Portion Food Service Request Form
Please complete all required fields.
Email address *
Last Name *
Your answer
First Name or Initial *
Your answer
Telephone Number *
Your answer
Gender *
Marital Status *
Parent Household *
Hampton Roads City *
Zip Code *
Your answer
Race *
# of people in the household *
Your answer
# of children in High School *
Your answer
# of children in Middle School *
Your answer
# of children in Elementary School *
Your answer
# of toddlers (2-4 years old) *
Your answer
# of infants *
Your answer
Anyone in the household receiving prenatal care? *
Would you like other services *
If yes, please check all that apply
Are you a member of of a church *
Church name, city, state
Your answer
How did you hear about Ruth's Portion Food Outreach? *
Today's Date *
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eSignature *
Type your name as a signature acknowledging request for food from the KĀMO: Ruth's Portion Food Outreach.
Your answer
Waiver and Release of Liability *
KAMO is a 501(c)3 Nonprofit organization, public charity. By the acknowledgment of this agreement, I accept and assume full responsibility for any and all injuries, damages (both economic and non-economic), and losses of any type, which may occur to me, and I hereby fully and forever release and discharge the Kingdom Authority Ministries Outreach dba KĀMO (The NPO), Ruth's Portion Food Outreach, its Officers, Directors, Volunteers, Associates, or Affiliates from any and all claims, demands, damages, rights of action, or causes of action, present or future, whether the same be known or unknown, anticipated, or unanticipated, resulting from or arising information, materials, or food items received. I expressly agree to indemnify and hold harmless Kingdom Authority Ministries Outreach dba KĀMO, Ruth's Portion Food Outreach against any and all claims, demands, damages, rights of action, or causes of action, of any person or entity, that may arise from injuries or damages sustained by me or my guest. I HAVE READ THE FOREGOING WAIVER AND RELEASE OF LIABILITY AND VOLUNTARILY EXECUTED THIS DOCUMENT WITH eSIGNATURE KNOWLEDGE OF ITS CONTENT.
Your answer
Please allow 24 - 48 hours for our Service Team to coordinate the delivery of the Ruth's Portion Food Distribution request. Thank you!
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