Neighborhood Pantry Registration Form



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Head of Household Details:                                                                                            
















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Primary Student
ALL Requested information needs to be completed

Please list the information of the Primary Student









Additional Family Members
ALL Requested information needs to be completed

Please list the Name of Each Additional Individual in your Household (ALL children and adults)










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Hold Harmless Agreement: By signing below, I hereby agree to indemnify, save, hold harmless, release, waive, discharge and covenant not to sue MUST Ministries, Inc., all schools located within Cobb County and Cherokee County School Districts, its officers, directors, employees, agents, and/or volunteers from any and all liability, claims, demands, actions and causes of action, and costs whatsoever arising out of or relating to any sickness, loss, damage or injury, including death, that may be sustained by me, or any member of my household, whether caused by the negligence of the releases or otherwise.  I am fully aware of risks and hazards connected with participating in the program and am fully aware that there may be risks and hazards unknown to me connected with participating in the program. I hereby elect to voluntarily participate in the program, knowing that conditions may be hazardous, or may become hazardous to me and/or the individuals in my household. I voluntarily assume full responsibility for any risks of loss, property damage or personal injury, including death that may be sustained by me and/or any individual in my household, including but not limited to those associated with food allergies whether known or unknown by me or any member of my household. I understand that it is my responsibility to inspect all products received from MUST Ministries, Inc. and the Neighborhood Pantries prior to consumption to ensure product’s safety. I also understand that is my responsibility to ensure that no food allergens are consumed by any member of my household. I authorize MUST Ministries, Inc. to seek and release information concerning myself and my family to any such person or agency as MUST deems appropriate in its attempt to determine eligibility and to provide assistance to me and/or my family. I completely release MUST Ministries (which includes officers, board members, employees, agents or volunteers) and agree not to hold MUST Ministries responsible for any claims, damages or causes of action whatsoever, known or unknown, which may now or in the future arise from or in connection with any such goods or services provided to me or my family by MUST Ministries. I further agree that I fully understand this release and have had the opportunity to ask any questions about this release, and they have been answered to my satisfaction.

Enter your name

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As a participant in the Neighborhood Pantry:

(Initials)

(Initials)

(Initials)

(Initials)

(Initials)

(Initials)

(Initials)

(Initials)
I have read, understand and agree to all guidelines set forth above.

Enter your name