Intake Application
Please answer all questions carefully so we may better serve you and your family. Your information is confidential and will not be shared with any outside agency or entity.
Waiver, Release of Liability and Indemnity
Important: Please read this document very carefully before signing.
I, the participant, desire to participate in or in connection with the FoodSHARE Program, Porchlight Community Services, Inc. and engage in activities related to being a participant.
Waiver and Release. I release, waive, and forever discharge and hold harmless PLCS, Inc. et al. and its successors and assigns from any and all liability, claims, demands, and/or causes of action of whatever kind or nature, either in law or in equity, for death, injury, property damage, or loss (“Claims”) which may arise from or related to my participation in on in connection with the Program.
Assumption of Risk I understand and acknowledge that participation in or in connection with the Program may expose me to inherently dangerous activities. I expressly assume all risks, both known and unknown, related to any injury, harm, property damage, death or loss arising from or related to participation in or in connection with these activities, as well as all other activities of the Program.
Photographic Release and Intellectual Property Rights. I grant and convey unto PLCS, Inc. all right, title, and interest, including all copyrights, in any and all photographic images and all writings or video or audio recordings made or created, in whole or in part, by me as part of my participation in or in connection with the Program.
Indemnity. I agree to indemnify and hold harmless PLCS, Inc. et al. from and against any Claims and legal fees related thereto which are caused by, arise from or relate to my actions or omissions, including, but not limited to, negligence, misdeeds, or violation of law.
Other Provisions. I understand and acknowledge that it is my intent that this Release shall be interpreted as broadly for the protection of PLCS, Inc. et al. as permitted by the law of the State of California, which is the exclusive law governing this Release.
I agree that in the event that any clause or provision of this Release shall be held to be invalid by any court of competent jurisdiction, the invalidity of such clause or provision shall not otherwise affect the remaining provisions of this Release, which shall continue to be enforceable.
I agree that the sole and exclusive venue for the litigation of any matter concerning this Release or its interpretation, or any liability for Claims, etc. set forth above, however so presented, pled or formulated, shall be either the courts of the State of California or through mediation.
I irrevocably waive my right to trial by jury and consent to trial by judge. Without limiting my intent that this Release fully discharge PLCS, Inc. et al., in the event that any judge shall determine that any part of this Release is not effective to accomplish this purpose, I limit my right of recovery to actual damages only, waiving any right to indirect or consequential damages, the recovery of loss of income, and punitive or exemplary damages.
Minor Children. If and to the extent that my minor children participate with me in the Program, I similarly release PLCS, Inc. et al. from any of the claims set forth above which my children may have against PLCS, Inc. et al. from or related to their participation in the Program and indemnify PLCS, Inc. et al. against Claims arising from their actions or omissions.
Review by Attorney. I acknowledge that I have been informed and that I understand that this Release is a legally binding instrument, which I am providing for the reliance of PLCS, Inc. et al., which have a right to rely on this Release.
I further acknowledge that I have been advised that I have the right to have this Release reviewed by an attorney before I sign it. By signing this Release, I acknowledge that I fully understand the meaning of this Release and all implications.
You are eligible for this service if:
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You live in Clairemont (92117), Bay Park (92110), Linda Vista (92111), or Serra Mesa (92123).
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You or a family member have food allergies or an autoimmune disease.
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You can demonstrate financial challenges, regardless of your income.
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Your household falls within federal low-income guidelines outlined below
In consideration of being allowed to participate in any way in the Free Food Basket Program, its related events and activities, I, the Participant, acknowledge, appreciate, and agree that:
There is a risk of property damage or personal injury from the activities involved in the Program, including but not limited to the potential for death or bodily injury; and
I assume all responsibility for all product/produce once it has been removed from Porchlight Community Services ("PCS, INC") and agree to release PCS, INC. from any and all liability. PCS, INC. strives to ensure that all product is fit for consumption. I, the Participant, am responsible for re-inspecting all products/produce acquired from my participation in the FBP.
I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, BOTH KNOWN AND UNKNOWN, EVEN IF ARISING FROM THE NEGLIGENCE OF THE "RELEASEES" (DEFINED BELOW) OR OTHERS, AND ASSUME FULL RESPONSIBILITY FOR MY PARTICIPATION;
I willingly agree to comply with all stated and customary terms and conditions for participation in the FBP. If, however, I observe any unusual or significant hazard or risk during my participation in the FBP, I will remove myself from participation and bring such hazard or risk to the attention of PCS, INC immediately.
I, for myself and on behalf of my heirs, assigns, personal and legal representatives, and next of kin, agree to assume all risks and to release, hold harmless and covenant not to sue PCS, Inc. or its officers, directors, employees, volunteers, officials, agents, attorneys, and affiliates, any designated beneficiaries, donors, sponsors, sponsoring agencies, participating schools or community organizations, and, if applicable, owners and lessors of premises used for the FBP or its activities (collectively, the "releasees"), for any claim, loss, or liability that I may have arising out of my participation in the FBP, including for bodily injury, death, or property damage, whether caused by negligence or carelessness of the releasees or otherwise.
I intend by this Waiver and Release to release in advance, and to waive my rights and to discharge all of the Releasees from, all claims, losses, or liabilities for personal injury, including but not limited to death or bodily injury, or property damage that I may have or claim to have, or which may hereafter accrue to me as a result of my participation in this event, even though that liability may arise from negligence or carelessness on the part of the Releasees, from dangerous or defective property or equipment owned, maintained, or controlled by them, or because of their possible liability without fault. I understand and agree that this Waiver and Release is binding on my heirs, assigns, personal and legal representatives, and next of kin.
(FOR FOOD SHARE PARTICIPANT PARENTS/GUARDIANS OF MINOR CHILDREN UNDER AGE 18) I, as parent/guardian with legal responsibility for MINOR CHILDREN, do consent and agree to their Waiver and Release of the Releasees as provided above, and, for myself and my heirs, assigns, personal and legal representatives, and next of kin, hereby release and agree to indemnify and hold harmless the Releasees from any and all claims and liabilities incident to my minor child's/ward's involvement or participation in this event as provided above, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES, to the fullest extent permitted by law.