iLEAD BSTEM Food Pantry Intake Form

Thank you for utilizing the iLEAD BSTEM Food Pantry. Please complete this form to help us better serve you and meet program requirements.

Please visit iLEAD's website: www.ileadbstem.org

Liability and Release Clauses:

Food Disclaimer/Liability Statement: By signing below, I acknowledge that I am voluntarily receiving food items from the iLEAD BSTEM Food Pantry. I understand that while all items have been stored and handled following food safety guidelines, iLEAD BSTEM is not responsible for any adverse effects resulting from the use or participating in food pantry activities.

Illness and Bodily Injury: I understand and agree that iLEAD BSTEM, its directors, officers, employees, and agents are not liable for any illness or bodily injury that may occur as a result of participating in activities or consuming products provided by the food pantry.

Personal Property: I acknowledge that iLEAD BSTEM is not responsible for the loss, theft, or damage of personal property while on the premises or participating in food pantry activities.

I grant iLEAD BSTEM permission to use my likeness in photographs, videos, or other media for promotional and educational purposes without compensation. I understand that these images may be used in various formats, including print and digital media.

By signing below, I release and hold harmless iLEAD BSTEM, its directors, officers, employees, and agents from any and all liability, claims, and demands of whatever kind or nature, either in law or in equity, which arise or may hereafter arise from my participation in the food pantry services.

Please Visit Our website: www.ileadbstem.org