Orange County United Way

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Are you signing up as a...

Company

Organization

Non-Profit

Individual

If you are signing up on behalf of a company, organization, or non-profit, what is the group name?

Contact Information

* Full Name:

* Email:

* Phone Number:

Please enter your three digit area code in the first box, followed by your seven digit phone number in the second box. Use the third box for your extension, if applicable.

* How many food boxes will you be making?

Are there any other details you would like to tell us about?

LIABILITY RELEASE:

* By checking this box: I hereby release, indemnify and hold harmless United Way, the organizers, sponsors, agency partners, and supervisors of all its activities, from any and all liability in connection with any injury and/or property damage (including any injury or property damage caused by negligence) associated with my participation in all events including volunteer events and other activities. I will not participate unless I complete this form in its entirety. This agreement will remain in force unless I notify United Way in writing. I UNDERSTAND that any in-person activity inherently involves a risk of possible coronavirus/COVID-19 exposure and that coronavirus/COVID-19 is communicable and can cause significant harm to persons, including, but not limited to, possible death. I also acknowledge that United Way cannot guarantee that I or any family member will not be exposed/become infected with coronavirus/COVID-19. By signing this agreement, I am acknowledging these risks for myself and my family members and voluntarily assuming such risks. I AGREE to follow and exercise all applicable precautions and guidelines set forth by the Centers for Disease Control and Prevention (CDC), California Department of Public Health, and local authorities, in connection with the coronavirus/COVID-19, including, but not limited to: social distancing, wearing face coverings, and appropriate hand hygiene. I AGREE to complete any required coronavirus/COVID-19 screening prior to participating in the activity and AGREE to any required contact tracing requirements or any other disclosures required by applicable authorities.

PHOTO AUTHORIZATION & RELEASE:

* By checking this box: I agree to permit photographs, video or digital tapes, movies and/or sound recordings of myself (or my child) for the purpose of television, radio, newspaper or outdoor advertising, billboards, bus covers, videos, printed materials, internet and/ or news stories. I (or my child) will not receive payment for these pictures and will have no right to view or approve them before or after they have been used. I understand that there is no time limit to this agreement. I hereby authorize and consent that United Way, its legal representatives, successors or assigns, shall have the absolute right to copyright, publish, use, sell or assign any and all photographic portraits or pictures, television spots, movie films, videotapes and/or sound recordings, or any part thereof, they have taken or made of me from this date forward or in which I may be included in whole or in part, whether apart from or in connection with, illustrative or written printed matter, story or news item, motion pictures, television or radio spots, or publications appearing on the internet or world wide web, or for publicity, advertising or any other lawful purpose whatsoever, in conjunction with my own or a fictitious name, or in reproductions thereof in color or otherwise. I hereby waive all claims for any compensation for such use or for damages, now or anytime in the future. I hereby waive any right that I may have to inspect and/or approve the finished product or the advertising copy that may be used in connection therewith or the use to which it may be applied, now or anytime in the future. I hereby warrant that I am of full age and have every right to contract in my own name in the above regard. Or, if the subject of said contract is a minor, I hereby consent and agree, individually, and as a parent or legal guardian of said minor, to all the terms and provisions stated above. I state further that I have read the above authorization and release, prior to its execution, and that I am fully familiar with the contents thereof.

Thank you for signing up to help families in our community. Your generosity provides a festive holiday meal and brings warmth, joy, and a sense of togetherness to the season.

Items marked with an asterisk(*) are required

Holiday Food Box Drive Sign-Up Form