MLK Day of Service 2023

Please wait...

Fields marked with an asterisk (*) are required.

The following form and waivers must be completed by all volunteers participating in Food Bank For New York City's MLK Day of Service on January 16th 2023. For any volunteers under the age of 18, the form and waivers must be completed by a parent/legal guardian.

Volunteer Type

Volunteer First Name

Volunteer Last Name

Volunteer Email

Youth Volunteer Email

Which project will you be participating in?

Youth Volunteer Date of Birth

All volunteers must be at least 10 years old as of 1/16/2023 in order to participate at the in-person Repack.

Parent/Legal Guardian First Name

Parent/Legal Guardian Last Name

Parent/Legal Guardian Email

Volunteer Waiver

I attest that I am physically fit and prepared to volunteer. In consideration of my acceptance as a volunteer, I hereby agree to release, defend, indemnify, and hold harmless Food Bank For New York City and its affiliates and sponsors and their officers, directors, employees, representatives and agents, from any and all claims for expenses, personal injury, losses or damages that may be incurred or caused by me during or in connection with my volunteering, whether arising from the negligence of such persons or otherwise (including, without limitation, arising from any exposure to COVID-19 and have read and signed the COVID-19 Waiver). If I am performing a task that requires leaving premises owned or leased by Food Bank For New York City or Food Bank For New York City Member Agency, I will not be under the supervision or control of a Food Bank For New York City Member Agency or Food Bank for New York City and will be acting on my own accord. I understand that for some projects, regardless of location, I will not be under the supervision and control of Food Bank For New York City. I have read and understand Food Bank For New York City’s Volunteer Code of Conduct.

I hereby give consent and authority to Food Bank For New York City to obtain medical treatment on my behalf if I am injured or require medical attention during my participation as a volunteer. I understand and agree that I am solely responsible for all costs related to such medical treatment, medical transportation, and/or evacuation. I hereby release, forever discharge, and hold harmless Food Bank for New York City from any claim whatsoever in connection with such treatment or other medical services. I declare that all of the statements made on this form are accurate and complete to the best of my knowledge.

Additionally, I declare that I have read and signed the Photo Release Form and COVID-19 Waiver, both of which shall be incorporated by reference.

I declare that all of the statements made on this form are accurate and complete to the best of my knowledge.

This field is required

I am the parent or legal guardian of the minor named above. I have the legal right to consent to and, by checking this box, I hereby do consent in all respects to the terms and conditions of this Volunteer Waiver Form and agree that both the minor and I shall be bound by all of its terms and conditions.

This field is required

Photo Authorization

I hereby authorize the Food Bank For New York City and its subsidiaries, affiliates and any individual or entity acting with its permission (“Food Bank”) to exploit, publicly display, reproduce, distribute, alter or otherwise use in perpetuity and in all places my name, voice, likeness, photograph, words and/or any other representation of me or my property (“Photo”) in connection with any video, audio, broadcast, cable, electronic, print or other media (“Media”) it creates, distributes, displays, transmits, exhibits or otherwise uses in connection with any internal or external advertising, promotional, fundraising, public relations, educational or other Food Bank program-related purposes (collectively, the “Materials”).

I understand and hereby agree that this authorization is granted to the Food Bank without any prior, current or future payment or other compensation or notice to me or approval by me, and further, that I will not have any rights of ownership or otherwise with respect to any Media used by the Food Bank and that the Food Bank may not necessarily use my Photo in any Media at any time.

Food Bank shall be the exclusive owner of all rights, including copyright, in the Materials. I hereby irrevocably transfer, assign, and otherwise convey to Food Bank my entire right, title, and interest, if any, in and to the Materials and all copyrights and other intellectual property rights in the Materials arising in any jurisdiction throughout the universe in perpetuity, including all registration, renewal, and reversion rights, and the right to sue to enforce such copyrights against infringers.

I hereby declare that I have every right to grant this authorization to the Food Bank without violating any other agreements or commitments I have made or giving rise to any consent, payment or other compensation due to any other person or entity thereunder.

I hereby release, discharge and hold harmless the Food Bank from any and all liability arising out of or relating to the foregoing.

I have read and understand this authorization and hereby acknowledge and agree that this authorization is a legally binding contract between me (and my heirs, assigns, executors and administrators) and the Food Bank and may not be waived, modified or amended by me without the express written consent of the Food Bank.

All matters arising out of or relating to this authorization shall be governed by and construed in accordance with the internal laws of the State of New York without giving effect to any choice or conflict of law provision or rule (whether of the State of New York or any other jurisdiction). Any claim or cause of action arising under this Agreement may be brought only in the federal and state courts located in New York, and I hereby irrevocably consent to the exclusive jurisdiction of such courts.

I declare that all of the statements made on this form are accurate and complete to the best of my knowledge.

This field is required

I am the parent or legal guardian of the minor named above. I have the legal right to consent to and, by checking this box, I hereby do consent in all respects to the terms and conditions of this Photo Authorization Form and agree that both the minor and I shall be bound by all of its terms and conditions.

This field is required

COVID-19 Waiver

I acknowledge that COVID-19 represents a serious health threat to persons exposed to it and I assume the risk associated with possible exposure to COVID-19 during my performance of any and all tasks related or connected in any way to Food Bank For New York City and/or a Food Bank For New York City Member Agency. I acknowledge that it is impossible for Food Bank For New York City and any Food Bank For New York City Member Agency to screen and/or monitor all individuals, whether employees, agents, volunteers, guests or otherwise, encountered during my performance of any and all tasks related or connected in any way to the Food Bank For New York City and/or any Food Bank For New York City Member Agency.

I certify, as of the date hereof, that during the last 14 days, neither I nor any member of my household has been exposed to, diagnosed with, or quarantined as a result of COVID-19 or have experienced a fever, cough, shortness of breath, or other cold or flu-like symptoms.

I agree to notify Food Bank For New York City and/or the applicable Food Bank For New York City Member Agency, as the case may be, if I, or any member of my household, has been exposed to, diagnosed with, or quarantined as a result of COVID-19 or is experiencing fever, cough, shortness of breath, or other cold or flu-like symptoms. In the event of such exposure, I acknowledge that I will not be permitted, nor have any authority, to volunteer for or on behalf of Food Bank For New York or any Food Bank For New York Member Agency, and will not appear at any of their locations, until the end of the quarantine period recommended by the Centers for Disease Control and Prevention (“CDC”) and the State of New York.

I agree to use best efforts to employ precautions recommended by the Centers for Disease Control and Prevention available at www.cdc.gov/coronavirus/2019-ncov/index.html, the State of New York, and any applicable local health department in order to minimize COVID-19 exposure to myself and others. I declare that all of the statements made on this form are accurate and complete to the best of my knowledge.

I declare that all of the statements made on this form are accurate and complete to the best of my knowledge.

This field is required

I am the parent or legal guardian of the minor named above. I have the legal right to consent to and, by checking this box, I hereby do consent in all respects to the terms and conditions of this Covid-19 Waiver Form and agree that both the minor and I shall be bound by all of its terms and conditions.

This field is required

Submit

MLK Day of Service 2023

ABOUT US

CONTACT

Common Messages