FAKH Individual/Family Waiver Form
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First name: *
Last name: *
Group/Organization (if applicable):
Mailing Address: *
City: *
State: *
Zip Code: *
Phone Number: *
Email Address: *
Date of Birth: *
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Name, Birthdate, Email, and Phone Number of Spouse, if serving with you:
Spouse's Name:
Spouse's Date of Birth:
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Spouse's Email Address:
Spouse's Phone Number:
Names and Birthdates of Child(ren) under 18, if serving with you:
Child 1's Name (if under 18):
Child 1's Date of Birth (if under 18):
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Child 2's Name (if under 18):
Child 2's Date of Birth (if under 18):
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DD
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YYYY
Child 3's Name (if under 18):
Child 3's Date of Birth (if under 18):
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Child 4's Name (if under 18):
Child 4's Date of Birth (if under 18):
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Liability Release & Waiver AND Photo Release

I agree to abide by Feeding America, Kentucky’s Heartland (FAKH) safety and sanitation standards. Closed-toe shoes are required in the warehouse. I understand that my volunteer activities with FAKH may include activities that could be hazardous to me, including but not limited to packing, loading, unloading and carrying heavy items. I understand there may be some risks involved by volunteering at FAKH. Knowing these facts, I hereby waive, release, discharge and agree to hold harmless FAKH, its agents, employees or anyone acting for or on its behalf from any and all claims of liability for illness, personal injury, death or property damage of any kind or nature whatsoever arising out of or in the course of my participation in any FAKH event. This release and waiver extends to all claims of every kind or nature whatsoever, foreseen or unforeseen, known or unknown and binds myself, my heirs, executors, administrators or anyone else who might claim on my behalf.

By signing below, I give my consent to be photographed or filmed while volunteering with FAKH, and hereby give my permission for any materials of me and/or the minor children volunteering with me as listed above to be used for informational and/or promotional purposes by FAKH.

E-Signature: *
Spouse's E-Signature:
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