Mt. Healthy Alliance Volunteer Application
7717 Harrison Avenue
Mt. Healthy, OH 45231
Tel: 513-521-3700

Instructions: Please enter your information. Questions with a red asterisk are required.
  • -----------------Volunteer Personal Information--------------------

  • - -
  • - -

  • - -
  • --------------------On-Going Volunteer Interest----------------------

  • --------------------------------------------------------------------------------------

  • The Mt. Healthy Alliance Food Pantry Hours of Operation are:

    ----Mondays, Thursdays, & Saturdays from 9 am till noon.
    ----Thursdays from 5 pm till 7 pm
    Special Events will be coordinated with the volunteers ie: holiday dinners
  • --------------------------------------------------------------------------------------

  • By submitting this form, I acknowledge that all the information on the Volunteer Application is correct and that I have reviewed and agree to abide by the Mt. Healthy Food Alliance Guidelines.

    We provide food & services; create stability & further self-reliance for people in crisis.

    The Mt. Healthy Food Alliance accepts volunteer placements through various resources. Some assignments involve strenuous and/or physical labor including, without limitation, lifting and climbing. I acknowledge my receipt of permission to volunteer for the Mt. Healthy Food Alliance. I also acknowledge my understanding that my service as a volunteer on or about the property used by Mt. Healthy Food Alliance or as a volunteer for a special program may expose me to various risks or injury or illness. In consideration of the permission and privilege allowed to me to serve as a volunteer, I agree and understand that I freely assume all risks, hazards, and losses which may befall me in connection with my exercise of the permission and privilege allowed to me by Mt. Healthy Food Alliance, and I agree not to hold Mt. Healthy Food Alliance, its agents, employees or volunteers liable for risk, hazard, injury, illness, property damage and/or loss.

    I understand that this Waiver and Release of Liability extends to and applies to any personal injuries, injurious results, damage or losses which I may experience or sustain while engaged in training for volunteer service or while engaged in serving as a volunteer for the Mt. Healthy Food Alliance.

    I promise for myself, my estate, executor, heirs and assigns not to sue or initiate any claim procedure against Mt. Healthy Food Alliance, its agents, employees, volunteers, assigns, or successors with respect to any risk, hazard, loss, injury, illness, or property damage I may experience or sustain arising directly or indirectly out of my volunteer activities with or at the Mt. Healthy Food Alliance.

    With your signature, you agree that Agency/Client information is to be considered confidential and proprietary. You will not disclose, publish, or otherwise reveal any information that can be identified as such without written authorization by the Mt. Healthy Food Alliance.
  • / /
Powered byEMF Web Form
Report Abuse