The SoLoved Bug Request Form

The SoLoved Bug

Mobile Donation Van Request Form
Requestors Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*

Area CodePhone Number
Organization or Church Name *
Organization or Church Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Book Date*
Time of event*

:HourMinutesAM/PM Option
What type of event*
Location of event*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Number of people expected*
What items are being requested*

HouseholdPersonal HygieneNon Perishable FoodSchool SuppliesAll of the above
I hereby forever release and waive my right to bring suit against SoLoved and its owners, officers, directors, managers, officials, trustees, agents, employees, or other representatives in connection with exposure, infection, and/or spread of COVID-19 related to utilizing SoLoved’s services and premises. I understand that this waiver means I give up my right to bring any claims including for personal injuries, death, disease or property losses, or any other loss, including but not limited to claims of negligence and give up any claim I may have to seek damages, whether known or unknown, foreseen or unforeseen.
Signature

Clear
Date

MonthDayYear
Date
Should be Empty: