WAIVER & RELEASE OF LIABILITY FORM -School Break Food Delivery Drivers

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Everyone must complete this form before doing any deliveries for Food4Kids Waterloo Region.
Thank you for helping feed the hope of children!

Email *

Name (First and Last) *

Address (House # & Street) *

City *

Postal Code *

Home Telephone # *

Cell Phone # *

My Partner's Name Include the name of the person you will be doing your deliveries with. NOTE: Each person does still need to fill out their own separate from for our records. We will match you up. Partner not confirmed yet? Enter COMING SOON and update us as soon as possible OR we will be in touch. Partners are mandatory! *

Volunteer Agreement, Waiver & Responsibilities (please check which break delivery program you are signing up for) *

Summer Break

Winter Break

Spring Break

Required

Driver Waiver (please check off each box applicable)

Vehicle Make & Model (helps us figure how many boxes will fit!) *

Vehicle License Plate Number *

The majority of our delivery routes are in Kitchener-Waterloo but approx. 40 of our families live in Cambridge. Are you willing to drive to Cambridge for deliveries? NOTE - Cambridge routes are noted in Sign Up Genius when you choose your route. *

YES

ON OCCASION IF NEEDED

Required

Vehicle Style *

Sedan

Med Size SUV

Large SUV

Mini Van

Truck

Required

Driver Details (please select application) *

I am currently carrying a valid - up-to date Ontario driver’s licence and a valid owner’s permit, licence plate and up-to-date liability insurance for my vehicle.

I am fully insured and currently hold up to date and valid liability insurance for my vehicle.

I agree to obey all traffic laws, rules of the road and drive in a safe and courteous manner While doing deliveries on behalf of Food4Kids wR

Required

General Duties *

I agree to deliver the food bins assigned to me to the HOME addresses on my route. I will be provided with a rolling hand cart, but understand there will be some light lifting as I unload my vehicle.

I understand that accessing every address is unique and some a bit challenging but I will do my best to deliver the food. If you experience any issues you may call back to our head office for assistance.

Upon arrival to each address, I agree to unload the bins and make a phone call to each family to let them know I am out front and ask them to come out and receive their food.

Required

Covid Specific

Your safety is paramount to us and due to strict safety precautions in place due to COVID 19, we need you to agree to the following:

Each week that I deliver, I will ensure that I have NOT been exposed to or am at risk of exposure to COVID-19. I will complete a verbal l self screening tool each week upon arrival before I head out.

I agree to wear a protective face mask and regularly sanitize my hands during my deliveries.

Food4Kids Waterloo Region values your safety and we do not want any of our volunteers to enter the homes or apartments buildings of our families during deliveries. If you choose to so, you do so at your own risk.

In the event that I do become ill, I will not hold Food4Kids WR liable and I assume all personal health risks.

Required

Submission Agreement

By submitting this form I waive, release and discharge Food4Kids Waterloo Region its trustees and officers  from any claims, demands, costs, causes of action, or damage as a result of property loss or damage, or personal injuries sustained to myself or any passengers traveling to & from locations of the addresses on my route. 

Furthermore, I intend this waiver & release to be legally binding on my heirs, executors, administrators, estate and assigns.

I, verify that the above information is true.

Submit

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