HFB 3/20
Please complete and return to:
Email: volunteer@hawaiifoodbank.org
PH: 808-954-7866 Fax: 808- 836-2272
Volunteer Opportunity: _____________________________
Date of Volunteer Opportunity: ____________________
Circle One: Mr. Mrs. Ms. Miss
Please Print Legibly
Name: _______________________________________________________
Address: _____________________________________
City: ______________
State: _______ Zip: _____________
Phone Home : ___________________________ Cell: __________________________ Work: ______________________
Email Address: _____________________________________________________________________
Emergency Contact Name: ____________________________________ E/C Phone: ___________________________
Group/Organization/ Agency: ___________________
Volunteer Application
Carpooling is highly recommended; parking is
prohibited at the Goodwill.
Covered shoes are mandatory. Cool comfortable clothingis also recommended. Handbags,
backpacks & other bulky items are discouraged. Ample cold bottled water will be provided
throughout the activity.
*
*
RELEASE AND WAIVER
I am volunteering to assist the Hawaii Foodbank in its events including but not limited to: donation solicitation, food drives and other such activities. I
understand there may be some risks involved in participating in any sponsored event. I consent to having my temperature taken prior to participation
and the foodbank is not liable if I am exposed to or contract COVID-19 during volunteer activities. Knowing these facts, I hereby waive, release, dis-
charge and agree to hold harmless the Hawaii Foodbank, its agents, employees or anyone acting for or on its behalf from any and all claims of
liability for personal injury, death or property damage of any kind or nature whatsoever arising out of or in the course of my participation. I understand
there may be some risks involved in participating in any sponsored 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. I further grant full permission to the Hawaii Foodbank or agents authorized by them to use any photographs, video and recordings or any other
record of this event for any Hawaii Foodbank purpose including: art, advertising, promotional collateral, publications, website and media in-cluding:
social, print, broadcast and electronic or digital media.
Parent/Guardian Permission
I verify that _______________________(print youth's name) is currently_______________years of age
and I, ____________________________ (print parent's/guardian's name) give permission for him/ her to
participate in a Hawaii Foodbank activity at the warehouse located at 2611 Kilihau Street, Honolulu, HI, 96819.
By my signature below, I acknowledge the above release and waiver.
DATE: __________________________
DATE OF BIRTH FOR YOUTH (UNDER 18): __________________
X _____________________________________________
SIGNATURE OF VOLUNTEER
X _____________________________________________
SIGNATURE OF PARENT/GUARDIAN (required for any one under 18)
Would you like to receive information about upcoming volunteer
opportunities?
Yes
No
In response to COVID-19 we are taking our lead from the State Department of Health and CDC to protect the health of our volunteers, staff, and
community. We are strictly enforcing the following: any volunteer who is exhibiting symptoms of illness or possible illness must remain home and
can resume volunteer shifts when they are medically cleared from all illness symptoms, without aid from medication. Should any volunteer arrive
at the warehouse showing symptoms of illness, we will kindly ask them go home.
Volunteer Eligibility Recommendations:
_____ I am not experiencing any common flu symptoms, i.e
cough, fever or shortness of breath.
_____ I have not had any contact with someone
who has exhibited coronavirus or other illness
symptoms in the past 14 days.
_____ I have not traveled in the past 14 days.
We will be enforcing the following procedures for
those well enough to volunteer:
- All persons entering the warehouse are required to
wash their hands.
- If you are handling food you will be required to wear
gloves (provided by the Hawaii Foodbank).
- Avoid touching your nose, eyes, and mouth.
- If you need to cough or sneeze, cover your nose/
mouth with a tissue or into your bent elbow, then wash
your hands.
____No exisiting chronic medical condition (i.e. diabetes,
heart disease).
