Broth Bank Sign Up Form

Use this form to sign up for broth and stay in touch (SoCal only)

MaxLove Project partners with the Electric City Butcher in Santa Ana, CA to provide free therapeutic bone broths to families in need locally who are facing childhood cancers or a related pediatric life-threatening illness. If your family qualifies and is in need, please consider utilizing the form below to sign up for the program.

Requestor's Name *
Requestor's Name
Phone Number *
Phone Number
Mailing Address *
Mailing Address
Are you able to pick up from our office in Orange, CA? *
Waiver *
I agree that I am voluntarily participating in, and receiving bone broth or other products ("the Product") from, MaxLove Project, Inc.'s Broth Bank ("Broth Bank"). I freely and voluntarily assume all risks for consumption of the Product(s) I receive from the Broth Bank, and waive any and all claims that I, or my heirs, assigns, next of kin, executors, or administrators may have in the future against MaxLove Project, Inc. and the chef or individual who prepared the Product(s) I receive, including their heirs, assigns, employees, directors, officers, representatives, agents, and successors (collectively “Releasess”). I hereby release the Releasees from any and all liability for any loss, damage, injury, or expense that I may suffer, or that my minor children may suffer, as a result of consumption or preparation of the Product(s) I receive from the Broth Bank. I also agree to hold harmless and indemnify Releasees against any and all claims, actions, damages, liability, and expenses that someone whom I served, shared, or otherwise provided the Broth Bank Products(s), and agree to pay all costs, including reasonable attorneys’ fees, associated with any claim against releases by any such person(s).