• Diaper Liability Form

    ALL STATEMENTS MUST BE ANSWERED AND AGREED IN ORDER TO RECEIVE FROM THE HEALING HURTS DIAPER BANK TO PROTECT THE GIVING AND RECEIVING OF SERVICES EXTENDED BY OUR NONPROFIT
  • I waive, release, and discharge Healing Hurts Ministries from any and all liability, including but not limited to, liability arising from the use of diapers and/or infant wipe products of any kind received from this Diaper Bank.*
  • I will not hold Healing Hurts Ministries and/or their directors, officers, employees, volunteers, representatives, agents, and the activity holders, sponsors, and volunteers liable for any issues or complications with the diapers, wipes, clothing, or resources received, whether caused by the conditions or contents of received services.*
  • I acknowledge that Healing Hurts Ministries and their directors, officers, volunteers, representatives, and agents are NOT responsible for the errors, omissions, or conditions of any products received on their behalf.*
  • I acknowledge that the diapers and/or products have been provided to this agency by donations from partnering agencies community organizations, entities, and individuals. Any risks or issues incurred as a result of these items are not the fault of Healing Hurts Ministries.*
  • I understand that receiving these donations are only done by my request for assistance to fulfill a need for my household.*
  • I am aware that my demographic information will be used as data to capture statistical reporting and program outcomes.*
  • Date of Request*
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  • Should be Empty: