Name: ________________________________________________________

Phone: ________________________

Email: ________________________________________

Mailing Address:

______________________________________________________________

City: ________________________________ State: __________

Zip: ____________________

If you would like to be a regular volunteer, have you completed a volunteer survey?

_________

Waiver of Liability

I understand that Salvation Farms is designed to let me pick excess farm produce for donation to Vermonters in need through connection with local and state agencies that serve the food and nutritionally insecure. I understand that I must work safely and treat participating farm property with respect and care.

With this Knowledge, I _______________________________, and anyone accompanying me, do hereby expressly agree that all our activities shall be at our sole risk and that neither Salvation Farms volunteers or its’ project leaders, nor the donors whose property we enter shall be held liable for any claims, demands, injuries, damages, actions, or causes of action whatsoever, to person or property arising out of or connected with our participation in this gleaning project.

Volunteer Signature: ________________________________________

Date: ______________

In Case of Emergency Notify:

Name: ___________________________________________________

Phone: _____________

Mailing Address:

______________________________________________________________

City: _______________________________ State: _______________

Zip: ________________

Relationship: _________________________________________________________________

SF Volunteer Registration & Waiver 5-22-06