Name *

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Participating as an individual or family?

Individual

Family

Preferred frequency to donate items?

Monthly

Quarterly

Are you willing to drop off items at a recipient’s home?

Yes

No

Are you willing to drop off items at a collection site?

Yes

No

How far are you willing to go to drop off items for recipients?

Five Miles

Ten Miles

Fifteen Miles

Expanding Villages will try to best match donors and recipients but will not monitor all communications regarding pick-up and drop-off details. This will be the responsibility of both parties until future pick-up and donation sites become available.

I acknowledge the program guidelines and agree

Expanding Villages will not be responsible for monitoring any goods or items received by recipients: ***Please note that all donations must be in good working order, readily useable without the need for repair, free of dirt, mold, water damage, pet hair, etc. Please do not try to donate any items that could be dangerous for recipients with children. Per Ohio Section 2305.37 a person donating perishable food or canned goods to needy individuals is not liable for harm; however, donors should take all precautions possible to donate only items in excellent condition that are not expired or recalled.

I acknowledge the program guidelines and agree