Furniture Donations
Email address
First Name
Your answer
Last Name
Your answer
Date of Birth
MM
/
DD
/
YYYY
Last 4 Digits of SSN#
Your answer
Current Street Address
Your answer
City
Your answer
State
Your answer
Zip Code
Your answer
Phone Number
Your answer
Referring Agency
Your answer
Referring Agency Contact Name
Your answer
Referring Agency Phone Number
Your answer
Did your current residence flood?
If "yes," what is your FEMA number?
Your answer
List name(s) and age(s) of others in household who live with you on a permanent basis. If none type N/A.
Your answer
Have you applied to another agency for assistance with household/furniture donations?
If "yes," please explain.
Your answer
Our goal is to distribute items to as many families as possible. Below, please select the items you need the most. Please make between 1 and 10 selections from the choices below.
Required
Below, please select the items you need the most. Please make between 1 and 10 selections from the choices below.
Required
I certify that the above information is true to the best of my knowledge. I understand if any of the above is not true I may forfeit my opportunity to receive furniture donations.
I understand that this application does not guarantee furniture availability.
I understand that applications are screened on a first come, first served basis.
I understand that I am responsible for the pick up and loading of any furniture donation I receive at a designated time.
RELEASE OF LIABILITY: I understand that the furniture through this program is for my personal use only. Donated furniture is not to be resold or used for commercial purposes. I understand that Volunteers of America of Florida may share my personal information with its partner agencies for the purposes of coordinating distribution. I understand that FurnishAid, VOA Florida and its partnering agencies cannot guarantee what style and make of furniture is distributed. I UNDERSTAND THAT I AM RESPONSIBLE FOR ALL PICK UP, LOADING AND DELIVERY SERVICES. FurnishAid, VOA Florida and it partnering agencies are not responsible for pick up, loading and delivery services nor will they provide any items such as tie down straps, tape, bungee cords, ropes or moving pads.
I waive any liability on the part of FurnishAid, VOA Florida and its partnering agencies in the case of physical injury to myself or damage to my personal property while engaged in picking up, loading or unloading donated furniture. FurnishAid, VOA Florida and its partner agencies are also not responsible for any future damages or injury connected to the donated furniture. In addition, I absolve the furniture manufacturer from any liability associated with donated goods.
PHOTO/VIDEO RELEASE: I give Volunteers of America of Florida, its nominees, agents and assigns my free and unlimited consent and permission, waiving all claims for any compensation by reason thereof or for damages to use, publish,/broadcast, republish/rebroadcast or exhibit in the furtherance of its work, with or without identification of me by name. And to disseminate statements referring to me in conjunction therewith if VOA Florida so desires and to authorize any media, company, partner agency or organization to use, publish/broadcast, republish/rebroadcast or exhibit said photograph/video with or without identification of me by name to publish/broadcast or disseminate statements referring to me in conjunction therewith in the promotion of VOA Florida and any of its fund-raising campaigns or marketing materials.
I have read the above information and agree to abide by the terms contained within. By signing this application, I certify that the answers I have provided are true, complete and accurate to the best of my knowledge.
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