Volunteer Release

Instructions Please go through the form below and fill out each line. When you are done please scroll to the bottom and verify the form and click submit. *Note: We will need a copy of your auto insurance and drivers license. You can upload a copy at the bottom of this form.

First and Last Name Please state (type) your name both first and last.

Please indicate with a yes or no answer *

You are applying to volunteer your services to Homebound Meals, Inc, as a driver/rider.YesNo

Please indicate with a yes or no answer *

I assume full responsibility for myself, passengers and use of my automobile to deliver the meals.YesNo

Please indicate with a yes or no answer *

I have adequate liability and property damage insurance for my vehicle and for my own protection. (Attach a copy of current insurance card at bottom of form).YesNo

Please indicate with a yes or no answer *

I have a current Indiana driver’s license (attach a copy at bottom of form).YesNo

Please indicate with a yes or no answer *

I certify that I have not been convicted of a Felony. I further certify that in the event I am convicted of any Felony that I will automatically be dismissed as a driver/rider from Homebound Meals, Inc. Further I understand that the Director regularly checks public databases.YesNo

Please type your name as a form of digital signature

Address

Your Address. Street, City, State and Zip Code.Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry

Email *

Home Phone *

Cell Phone

Please type your date of birth.

Date Please Select Today's Date

Upload insurance info here.

Upload Drivers License info here.

Release Form

Verification