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Select ALL Sources of Income Monthly
Does your household currently receive any of the following?(Select all that apply)
Additional Household Member #1 Info
Additional Household Member #2 Info
Additional Household Member #3 Info
Additional Household Member #4 Info
Additional Household Member #5 Info
Additional Household Member #6 Info
Please list any additional members names and dates of birth here:
 
 
 
 
           
 

WAIVER OF LIABILITY

 

By submitting the Online Application, you are agreeing to the following Waiver of Liability:

 

As the recipient of the donated food and other goods, including, but not limited to, toiletries, cleaning supplies, household goods and toys (Donations) received from Love One Another Embassy, Inc. dba Joseph’s Storehouse Food Ministry (Donor), I and my household members (Donee) hereby waive and release any rights, actions or claims against Donor, its current and future officers, directors, trustees, employees, successors, assigns, agents and representatives for any liabilities, losses, damages, settlements, and/or judgements, directly or indirectly arising out of or related to the consumption, use, further disposition, or transfer of Donations by Donee or any other person or entity, including, but not limited to, any food-borne illnesses and death, arising out of or in connection with Donee’s consumption or use of Donations received from Donor.  Donee recognizes that there are certain inherent risks associated with Donations and Donee assumes full responsibility for any personal injury to any person(s) that may result. Donations will be personally used by Donee and their immediate family only and will not be sold, bartered or exchanged for any reason. 

 

I understand that misrepresentation of the facts, and/or selling, trading, bartering, or otherwise using donated food and/or other donated items in any way other than for my immediate household listed above will result in my inability to receive further donations from Love One Another Embassy, Inc. dba Joseph’s Storehouse Food Ministry.

 


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