Become a Mitzvah Food Program Client – Jewish Federation of Greater Philadelphia

Thank you for your interest in becoming a Mitzvah Food Program client.

We are here to provide you and your family with fresh, frozen and nonperishable food with kosher options.

In order to begin the process of becoming a client, we ask that you fill out the following form. If you have any questions, contact mitzvahfoodprogram@jewishphilly.org or 215.832.0509.

Please know that this form is not mandatory to receive food in person. This information is confidential and will not affect your eligibility for food. Every question must be answered clearly (N/A, none, or 0 if your answer does not apply). Our four pantries distribute nutritious food to all who are in need, regardless of race, income, gender, age, or religion. Additionally, this information is only required in order to become a full client of our pantry, not to receive emergency food.

Basic Information

Today's Date(Required)

Choose One Pantry Location(Required)

Old York Road (Beth Sholom Congregation)

Lower Bucks County (Congregation Tifereth Israel)

Center City (Jewish Community Services Building)

Northeast (KleinLife)

Mainline (JFCS Brodsky Building)

I don’t know which one to choose/help me decide

Do you have mobility issues?(Required)

Yes

Do you need delivery services?(Required)

Yes

Why are you requesting the delivery option?(Required)

This is a mandatory field if you answered that you do need delivery. For example: You are home-bound, or because your work schedule makes it impossible for you to come to the pantry during the hours that it is open, no one is able to come to the pantry for you to pick up (a proxy), or you don’t have access to transportation. Please note that it may take time to place you on a delivery route as we depend on volunteers to deliver to you.

Name(Required)

First Last

Address(Required)

If you are currently unhoused, insert “unhoused” under street address.

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Address

If you are currently unhoused, insert “unhoused” under street address.

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Can you provide your…

Phone Number

Both

I do not wish to share by phone or email

Phone

Cell Phone (if different than above)

Can you provide your…(Required)

Phone Number

Both

Phone(Required)

Cell Phone (if different than above)

Email(Required)

What is the best way to contact you?

Phone

What is your primary language?(Required)

Are you comfortable speaking in English(Required)

Yes

Somewhat

Religious Affiliation(Required)

What is your religious affiliation?(Required)

Do you have Jewish heritage?(Required)

Yes

Are you or is someone in your house a Holocaust Survivor?(Required)

Yes

Dietary Information

Do you keep kosher?

Yes

Kosher designates food that satisfies the requirements of Jewish law. This means, in short, that no meat and dairy can be consumed together, no shellfish (including lobster and shrimp), and no pork may be eaten. Also, in order to be kosher, kosher animals must be butchered in a specific way that satisfies the requirements of Jewish law.

Do you keep kosher?(Required)

Yes

If you keep Kosher, do you keep to "Orthodox Union" (OU) standards or higher?(Required)

Yes

Are you willing to receive vegetarian food items that may not bear explicit Kosher certification?(Required)

Yes

Are you willing to receive vegetarian food items that may not bear explicit Kosher certification?

Yes

Does someone in your house have special dietary needs?(Required)

Low Salt

Low Sugar

Celiac (Gluten Free)

Lactose Intolerant

Nut Allergy

None

Other

Does someone in your house have special dietary needs?

Low Salt

Low Sugar

Celiac (Gluten Free)

Lactose Intolerant

Nut Allergy

None

Other

Other(Required)

Household Income Information

How many people in your household, including yourself?

How many people in your household, including yourself?(Required)

Is any member of your household a US Veteran?(Required)

Yes

Name(s) of all US Vetreans in your household(Required)

Do you or any member of your Household identify as LGBTQIA+(Lesbian, Gay, Bisexual, Transgender, Queer or Questioning)?(Required)

Yes

Members of Household Information

Please fill out the information below for every person in your household including yourself.

Person 1 (You)

Name(Required)

First Last

Date of Birth(Required)

Gender:(Required)

Male

Female

Trans Man

Trans Woman

Non-binary

Prefer not to answer

Work Status(Required)

Citizenship Status(Required)

US Citizen

Green Card / Permanent Resident

Immigrants

Refugees/Asylees

Other

Race(Required)

Person 2

Name Of Person 2(Required)

First Last

Date of Birth or Age(Required)

Gender:(Required)

Male

Female

Trans Man

Trans Woman

Non-binary

Prefer Not to Answer

Work Status(Required)

Citizenship Status(Required)

US Citizen

Green Card / Permanent Resident

Immigrants

Refugees/Asylees

Other

Race(Required)

Relationship to Head of Household(Required)

Person 3

Name of Person 3(Required)

First Last

Date of Birth or Age(Required)

Gender:(Required)

Male

Female

Trans Man

Trans Woman

Non-binary

Prefer Not to Answer

Work Status(Required)

Citizenship Status(Required)

US Citizen

Green Card / Permanent Resident

Immigrants

Refugees/Asylees

Other

Race(Required)

Relationship to Head of Household(Required)

Person 4

Name of Person 4(Required)

First Last

Date of Birth or Age(Required)

Gender:(Required)

Male

Female

Trans Man

Trans Woman

Non-binary

Prefer Not to Answer

Work Status(Required)

Citizenship Status(Required)

US Citizen

Green Card / Permanent Resident

Immigrants

Refugees/Asylees

Other

Race(Required)

Relationship to Head of Household(Required)

Person 5

Name of Person 5(Required)

First Last

Date of Birth or Age(Required)

Gender:(Required)

Male

Female

Trans Man

Trans Woman

Non-binary

Prefer Not to Answer

Work Status(Required)

Citizenship Status(Required)

US Citizen

Green Card / Permanent Resident

Immigrants

Refugees/Asylees

Other

Race(Required)

Relationship to Head of Household(Required)

If there are more than 5 members of your household, please list them with all their pertinent information here.

Additional Information

How did you hear about the Mitzvah Food Program?(Required)

Friend/Family Member

Internet Search

Philabundance, Share Food Program, MAHN, BCOC or another organization

Religious Institution/Leader

Social Worker

Social Worker Organization(Required)

Social Worker Full Name(Required)

Social Worker Email(Required)

Social Worker Phone Number(Required)

Consent(Required)

I agree to the privacy policy.

I (hereinafter the “Undersigned”) wish to receive services from a Volunteer and/or Agent through the Mitzvah Food Program (hereinafter referred to as “MFP”) service. The Undersigned understands that the Volunteer and/or Agent will perform certain activities related to serving as a volunteer and/or agent (“the Activities”).

Scope of Volunteer Position: The Undersigned understands that the scope of the Volunteer’s relationship with MFP is limited to a volunteer position; that the Volunteer is not an employee of MFP and no compensation is expected in return for services rendered; that MFP will not provide any benefits to the Undersigned beyond connecting the Undersigned and the Volunteer; and that the Undersigned is responsible for his/her/their own insurance coverage in the event of personal injury or illness arising out of the Activities.

Scope of MFP’s Role: The Undersigned expressly acknowledges that MFP is acting solely as an intermediary between beneficiaries in need of services and volunteers and/or agents willing to provide such services; that MFP’s involvement ceases once a volunteer and/or agent is connected with a beneficiary; and that MFP exercises no control over the receipt of services or any other agreement between the Undersigned and the Volunteer and/or Agent.

Release, Waiver and Indemnification: The Undersigned hereby releases, waives, discharges and covenants not to sue MFP and/or its insurers, its attorneys, its insurer’s attorneys, or anyone for whom MFP or its insurer may be legally liable (herein the “Releases”) for liability to the Undersigned, his/her/their personal representatives, employers, insurers, assigns, heirs, and next of kin due to any and all loss or damage, and any claim or demands therefore on account of injury to Undersigned’s person or property or resulting in death of Undersigned, whether caused by the negligence of the Releasees, or Volunteer, or Agent, or otherwise while Volunteer and/or Agent is on or around the Premises or in any way arising out of the Activities.

The Undersigned further hereby assumes full responsibility for and risk of bodily injury, death or property damage due to the negligence of Releases, or Volunteer, or Agent, or otherwise while on or around the Premises or in any way arising out of the Activities. The Undersigned further agrees to defend and indemnify and hold Releasees harmless from and against any and all loss, damages, injuries, liability, claims, suits, costs and expenses whatsoever, including reasonable attorneys’ fees, regardless of the merit or outcome of any such claim or suit arising from or in any manner connected to the Activities.

The Undersigned further expressly agrees that the foregoing release, waiver, and indemnity agreement is intended to be as broad and inclusive as is permitted by the law of Pennsylvania and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

The Undersigned has read and voluntarily signs this release, indemnity and waiver of liability agreement and further agrees that no oral representations, statements, or inducements apart from the foregoing written agreement have been made.

In lieu of a signature, please enter your name below. (This name is the aforementioned “Undersigned")(Required)

Learn More

Back to MFP Homepage

Contact

mitzvahfoodprogram@jewishphilly.org

215.832.0509