Culinary Angels Consent, Liability Waiver, and HIPAA Acknowledgment

Culinary Angels is a nonprofit organization that provides free, nutrient-rich meals and nutrition education to individuals undergoing cancer treatment and their caregivers. In order to receive services, we require your acknowledgment and agreement to the following terms:

1. Voluntary Participation and Consent to Receive Services

I voluntarily consent to receive home-delivered meals and/or nutrition education services from Culinary Angels. I understand these services are offered free of charge and are intended as a community support resource—not as a replacement for professional medical care or treatment.

2. Food Allergy Disclosure and Assumption of Risk

I understand that meals provided by Culinary Angels are prepared in a shared-use kitchen facility that is not certified as allergen-free. Despite Culinary Angels’ best efforts to accommodate dietary needs, meals may contain or come into contact with common food allergens, including but not limited to:

• Nuts (tree nuts and peanuts) 
• Gluten/wheat 
• Dairy (milk, cheese, etc.) 
• Eggs 
• Soy 
• Shellfish or fish 
• Sesame and other seeds 

I acknowledge that:

• Culinary Angels cannot guarantee the absence of cross-contact with allergens. 
• I have disclosed all known allergies or food sensitivities. 
• I accept full and sole responsibility for any allergic or adverse reaction that may result from consuming meals provided. 
• I will promptly notify Culinary Angels in writing if my dietary needs or medical condition changes. 

3. Medical Disclaimer

I understand that the meals and any nutrition-related education provided by Culinary Angels are not medical treatment, and should not be considered medical advice. I have consulted with my physician or licensed healthcare provider regarding any dietary restrictions or concerns. Culinary Angels does not employ licensed medical professionals and does not assume responsibility for clinical outcomes.

4. Waiver of Liability and Indemnification

To the fullest extent permitted by law, I hereby release, discharge, waive, and hold harmless Culinary Angels, its officers, employees, volunteers, agents, board members, affiliates, and partners from any and all liability, claims, damages, demands, or causes of action that may arise from:

• Allergic or medical reactions related to meal ingredients 
• Accidental exposure to allergens 
• Improper handling or consumption of meals after delivery 
• Any loss, injury, illness, or damage resulting from participation in this program 

I agree to indemnify and defend Culinary Angels against any third-party claims arising out of or related to my receipt or use of services.

5. Privacy and HIPAA Acknowledgment

I understand that in order to provide appropriate meal and nutrition services, Culinary Angels may collect and store certain health-related information, including but not limited to:

• Medical conditions relevant to dietary needs (e.g., cancer treatment, diabetes) 
• Food allergies or sensitivities 
• Physical limitations or housing circumstances that affect delivery 

Although Culinary Angels is not a “covered entity” under the Health Insurance Portability and Accountability Act (HIPAA), the organization voluntarily adheres to confidentiality best practices, including:

• Restricting access to sensitive information to authorized staff and volunteers 
• Never disclosing personal health information to third parties without express consent, unless required by law 
• Retaining only the minimum necessary information for service provision 
• Allowing me to request access to, or deletion of, my personal information at any time 

I authorize Culinary Angels to collect, store, and use this information solely for the purpose of coordinating services and improving program quality.

6. Program Guidelines and Termination

I understand that:

• I must provide accurate and complete information to be eligible for services. 
• Culinary Angels may suspend or discontinue services at its sole discretion if it determines that services are no longer appropriate, or if program guidelines are not followed. 

Services may also be paused or canceled due to capacity, safety, or operational limitations.