Volunteer Info Form and Waiver - 2018 Season
We are excited for you to volunteer with The Gleaning Project this year! Each volunteer must complete our info form and waiver, even if they have volunteered in years past. Please fill out this form in its entirety. Your information will not be shared, except in the case of an emergency.

For more information about what we do, visit: www.thegleaningproject.org or e-mail questions to thegleaningproject@gmail.com

First Name *
Your answer
Last Name *
Your answer
Birthdate *
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Address 1 *
Your answer
Address 2 *
Your answer
Email *
Your answer
Phone Number
Your answer
Want to get updates from us? Let us know if you would like to receive emails about the following. For descriptions of these roles please visit www.thegleaningproject.org/volunteer. Check all that apply *
Required
I/my family have received gleaned produce or other services from SCCAP (It is helpful to know how many families that we serve, volunteer their time with SCCAP)
Photos/videos/audio recordings of myself or my child may be used by SCCAP for news and promotional purposes (Pictures help us spread the word and gain support) *
Required
I would like to volunteer in: *
Required
Medical Information and Liability Waiver
This information will only be used in the case of an unlikely emergency during your time with us. Please list all relevant information.
List any allergies to medications, foods, etc. *
Your answer
List any history of serious illness (diabetes, asthma, heart disease, epilepsy, etc.) or recent injuries or hospitalizations *
Your answer
Medications you are currently taking *
Your answer
Name of Emergency Contact *
Your answer
Relationship to you *
Your answer
Emergency Contact Phone Number *
Your answer
Emergency Contact Address *
Your answer
Emergency Contact City, State, Zip *
Your answer
In the event I/my child suffer(s) any illness or accident requiring emergency hospitalization, medication, or surgery while participating in a gleaning event organized by The Gleaning Project of South Central PA. I understand that reasonable care will be exercised by the staff of The Gleaning Project to protect the safety of those involved. I will not hold employees or volunteers of The Gleaning Project, South Central Community Action Programs, Inc. (SCCAP) liable for injury, bodily harm, accidents or death of myself/my child during gleaning events. I will not hold the person(s) who own and/or operate either the property from which I/my child glean, or the property to which gleaned produce is delivered liable for accidents, injury, or death while participating in gleaning events.
By typing your full name below you are acknowledging that you have read the above information, and completed this form in its entirety.
Volunteer Signature *
Your answer
Parent/Gaurdian Signature if volunteer is under 18
Your answer
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