Senior Gleaners, Inc.

Volunteer Agreement and Release from Liability

Voluntary Participation

1. ________________(name), acknowledge that I have voluntarily applied to participate in food collection, transfer, and distribution of food to deserving and underprivileged individuals, families and other charitable or religious organizations at the premises of SENIOR GLEANERS, INC. (also known as SGI) at 1951 Bell Avenue, Sacramento, CA or other location to be specified by the organization.

Assumption of Risk

2. I AM AWARE THAT BENDING, STOOPING, REACHING, KNEELING, LIFTING, AND/OR CARRYING, WAREHOUSE WORK, FORK LIFT OPERATION AND LOADING, AND UNLOADING TRUCKS ARE HAZARDOUS ACTIVITIES. I AM VOLUNTARILY PARTICIPATING IN THESE ACTIVITIES WITH KNOWLEDGE OF THE DANGER INVOLVED, AND I HEREBY AGREE TO ACCEPT ANY AND ALL RISK OF INJURY OR DEATH, AND VERIFY THIS STATEMENT BY PLACING MY INITIALS HERE:_____

3.  As consideration for being permitted by SGI or one of its affiliated organizations to participate in these activities and use their facilities. I hereby agree that I, my assignees, heirs, distributes, guardians, and legal representatives will not make claim against, sue, or attach the property of SGI or any of its affiliated organizations, or the supplier of any of the equipment I will use in these activities, for injury or damage resulting from the negligence or other acts, how so ever caused, by any representative, volunteer, employee, agent, or contractor of SGI or any of its affiliated organizations as a result as a result of my participation in food collection, movement, and distribution of goods. I hereby release SGI and any of its affiliated organizations from all actions, claims, or demands that I, my assignees, heirs, distributes, guardians, and legal representatives now have or may hereafter have for injury or damage resulting from my participation in food collections, movement, and distribution.

4.   I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT BETWEEN MYSELF AND SGI AND/OR ITS AFFILIATED ORGANIZATIONS AND SIGN IT OF MY OWN FREE WILL.

Executed at Sacramento, California on_____(month),_____(day), 20_____

RELEASOR

___________________________(Signature of Volunteer)

If Volunteer is under the age of eighteen (18) his/her parent or guardian must also sign.

PARENT OR GUARDIAN OF VOLUNTEER

____________________________Signature)

____________________________(Printed Name)

I grant full permission to SGI to use any photographs, film, video or audio tapes of me performing volunteer work for any purpose SGI deems appropriate.___Yes___No (initial)

Declaration of Witness

I certify that ____________________(name of Releaser or Releaser’s Parent or Guardian) acknowledged in my presence that he or she read and fully understood the meaning of the consequences of the foregoing release, and signed it in my presence.

Executed at Sacramento, California, on __________20____.

WITNESS______________________________(Signature of Witness)