top of page


Being the undersigned individual, I hereby acknowledge that I will be engaged in volunteer service in the form of special events, warehouse, office and related duties for the Twelfth Street Food Pantry. I agree to perform volunteer duties to which I am assigned to the best of my ability and in a professional manner. I am aware that volunteering at the Twelfth Street Food Pantry involves certain risks, which may include bodily injury and property damage. Therefore I acknowledge and agree as follows:



Twelfth Street Food Pantry is not responsible for any accident, injury, damage, loss or liability incurred by me, while volunteering services for Twelfth Street Food Pantry or as part of a Twelfth Street Food Pantry project. I agree not to hold responsible, and covenant not to sue, Twelfth Street Food Pantry and its former or current directors, Board of Directors, employees, agents, predecessors, successors, assigns, representatives, attorneys, subsidiaries, and affiliates for any and all liability, lawsuits and/or claims which may arise from or otherwise be connected with a Twelfth Street Food Pantry project, special event or volunteer service, including but not limited to any physical injury, or other injury or damage to me or my property, whether occurring on or off the premises owned or operated by the Twelfth Street Food Pantry..


FOR PANTRY HELPERS: I acknowledge that part of my volunteer work may require that I will take part in heavy lifting up to 50 pounds. I am in good health and have no known physical condition that would prevent me from participating in such volunteer work.



I understand that Twelfth Street Food Pantry has limited medical liability insurance. I am solely responsible for ensuring that I have adequate coverage for any injuries or damages sustained by me while volunteering with Twelfth Street Food Pantry.



I agree that Twelfth Street Food Pantry may photograph me and/or record my voice and image, (collectively, “image”) and use my image and/or statements for advertising, publicity, display, publication or other promotional purposes. I agree that the Twelfth Street Food Pantry shall have the unrestricted right to choose the media (print publications, television, radio, Internet, or other media) for display of my image. I warrant that I have not limited the use of my photograph, voice and/or name to the use of any organization or person.


This agreement shall be interpreted in accordance with the laws of the State of Michigan and any dispute regarding the enforceability of this Agreement shall be filed in the courts of the State of Michigan, and shall not be transferred to any other jurisdiction. This Agreement is intended to be as broad and inclusive as permitted by law, and if any provision thereof is held invalid, the balance shall continue in full legal force and effect.


I have read and understand the terms of the Agreement, and hereby sign this agreement freely and of my own accord, realizing that it is binding upon me, my heirs, personal representative and next of kin.


____________________________________                ___________________________________   _____________

Volunteer Name (Print)                                                    Volunteer Date & Times


________________________________________              _______________________________________________

Phone Number E-Mail


________________________________________    __________________       __________        _______________

Address City State Zip


­­­­­­­­­­­­­­­­­­_________________________________________________          _______________________________________

Emergency Contact Name                                                                  Emergency Contact Phone



Group Name/Church/Company/Organization




Volunteer Signature (Parent/Guardian if under 18)





bottom of page