Meals on wheels, Industry, Inc.
volunteer application

Date of Application
Date of Application
Name *
Name
Address *
Address
Phone (Mobile)
Phone (Mobile)
Phone (Home)
Phone (Home)
Birthdate
Birthdate
Military Service?
Have you ever been convicted of a misdemeanor or felony?
Driver Information
Meals on Wheels, Industry, Inc. will not be held responsible if you are involved in any type of accident while volunteering your services.
Driver's License Expiration
Driver's License Expiration
Start Date
Start Date
Expiration Date
Expiration Date
Employer Information
Employer Address
Employer Address
Employer Phone
Employer Phone
May we contact your employer?
Reference
Reference Phone
Reference Phone
Emergency Contact
Contact Address
Contact Address
Contact Phone
Contact Phone
Delivery
Indicate the Route/Area you'd prefer to volunteer for delivering meals:
What is your availability for delivering meals?
Frequency of Availability
Meals on Wheels, Industry, Inc. Hold Harmless Agreement
Please read carefully! This is a legal document that affects your legal rights! This Release and Waiver of Liability (the “Release”), in favor of Meals On Wheels – Industry, Inc., a California nonprofit corporation, their officers, employees, and agents (collectively, “Meals On Wheels”). The Volunteer desires to work as a volunteer for Meals On Wheels and engage in the activities related to being a volunteer (the “Activities”). The Volunteer hereby freely, voluntarily, and without duress executes this Release under the following terms: Release and Waiver. Volunteer does hereby release and forever discharge and hold harmless Meals On Wheels and its successors and assigns any and all liability, claims, and demands of whatever kind or nature, either in law or in equity, which arise or may hereafter arise from Volunteer’s Activities with Meals On Wheels. Volunteer understands that this Release discharges Meals On Wheels from any liability or claim that the Volunteer may have against Meals On Wheels with respect to any bodily injury, personal injury, illness, death, or property damage that may result from Volunteer’s Activities with Meals On Wheels, whether caused by the negligence of Meals On Wheels or of its officers, directors, employees, or agents or otherwise. Volunteer also understands that Meals On Wheels does not assume any responsibility for or obligation to provide financial assistance or other assistance, including but not limited to medical, health, or disability insurance in the event of injury or illness. Medical Treatment. Volunteer does hereby release and forever discharge Meals On Wheels from any claim whatsoever which arises or may hereafter arise on account of any first aid, treatment, or service rendered in connection with the Volunteer’s Activities with Meals On Wheels. Nature of the Activities. The Volunteer understands that the Activities may include work that may be hazardous to the Volunteer, including, but not limited to, loading and unloading, and transportation to and from recipients. Volunteer hereby expressly and specifically releases Meals On Wheels from all liability for injury, illness, death, or property damage resulting from the Activities. Insurance. The Volunteer understands that, except as otherwise agreed to by Meals On Wheels in writing, Meals On Wheels does not carry or maintain health, medical, auto, or disability insurance coverage for any volunteer. Each Volunteer is expected and encouraged to obtain his or her own medical or health insurance coverage. Other. Volunteer expressly agrees that this Release is intended to be as broad and inclusive as permitted by the laws of the State of California, and that this Release shall be governed by and interpreted in accordance with the laws of the State of California. Volunteer agrees that in the event that any clause or provision of this Release shall be held to be invalid by any court of competent jurisdiction, the invalidity of such clause of provision shall not otherwise affect the remaining provision of this Release which shall continue to be enforceable. Volunteer has executed this Release as of the day and year first identified in the Volunteer Application.
Full Name
Full Name
By entering your full name in the box below (as it matches the name on the application) and checking the “Yes” box below, you signify your agreement to abide by the Volunteer Application/Hold Harmless Agreement of Meals on Wheels, Industry, Inc.
Do you agree to this release?